MEDICARE: ALSANA WEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1891463915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALSANA WEST LLC

Provider Business Mailing Address
First Line	:	1855 BOWLES AVE STE 210
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 SUNSET HILLS BLVD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-6900
Country	:	US
Telephone Number	:	888-822-8938
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLIENT FINANCES
Name	:	HEATHER WILHELM
Credential	:
Telephone Number	:	314-222-7441

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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