Healthcare Provider Details

I. General information

NPI: 1952880254
Provider Name (Legal Business Name): ALSANA WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 OLIVE ST STE A
SANTA BARBARA CA
93101-1406
US

IV. Provider business mailing address

1855 BOWLES AVE STE 210
FENTON MO
63026-1900
US

V. Phone/Fax

Practice location:
  • Phone: 143-222-7441
  • Fax:
Mailing address:
  • Phone: 314-222-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HEATHER WILHELM
Title or Position: DIRECTOR OF CLIENT ACCOUNTS
Credential:
Phone: 636-779-1444