Provider Demographics
NPI:1386235554
Name:FIRST ALLIANCE HEALTHCARE OF OHIO
Entity type:Organization
Organization Name:FIRST ALLIANCE HEALTHCARE OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-450-0351
Mailing Address - Street 1:11201 SHAKER BLVD SUITE 308
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104
Mailing Address - Country:US
Mailing Address - Phone:216-417-8813
Mailing Address - Fax:
Practice Address - Street 1:27600 CHAGRIN BLVD SUITE 300
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44104
Practice Address - Country:US
Practice Address - Phone:216-417-8813
Practice Address - Fax:216-916-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0353381Medicaid
OH0314657Medicaid