Provider Demographics
NPI:1154895993
Name:ALANO CLUB OF TERRE HAUTE
Entity type:Organization
Organization Name:ALANO CLUB OF TERRE HAUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-230-4265
Mailing Address - Street 1:1330 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2635
Mailing Address - Country:US
Mailing Address - Phone:812-230-4265
Mailing Address - Fax:812-645-0708
Practice Address - Street 1:1330 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2635
Practice Address - Country:US
Practice Address - Phone:812-230-4265
Practice Address - Fax:812-645-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility