Healthcare Provider Details

I. General information

NPI: 1013587716
Provider Name (Legal Business Name): FIRST ALLIANCE HEALTHCARE OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD STE 308
CLEVELAND OH
44104-3871
US

IV. Provider business mailing address

11201 SHAKER BLVD STE 308
CLEVELAND OH
44104-3871
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-8813
  • Fax:
Mailing address:
  • Phone: 216-417-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DAVID ALEXANDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-450-0351