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General NPI Number Information
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NPI Number | 1043412869
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Entity Type | Organization
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Legal Business Name | THIRD STREET ALLIANCE
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 41 N 3RD ST
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City | EASTON
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State | PA
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Zip | 18042-3642
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Country | US
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Telephone | 610-258-6271
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Fax | 610-258-2112
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Provider Business Mailing Address
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Address Line | 41 N 3RD ST
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City | EASTON
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State | PA
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Zip | 18042-3642
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Country | US
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Telephone | 610-258-6271
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Fax | 610-258-2112
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MAHPAREH FAKHRAIE
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Credential |
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Telephone | 610-258-6271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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