Provider Demographics
NPI:1427608967
Name:ALIVE EDUCATION MANAGEMENT AND SERVICES
Entity type:Organization
Organization Name:ALIVE EDUCATION MANAGEMENT AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, BCBA
Authorized Official - Phone:818-795-5206
Mailing Address - Street 1:14622 VENTURA BLVD STE 2175
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3600
Mailing Address - Country:US
Mailing Address - Phone:818-795-5206
Mailing Address - Fax:
Practice Address - Street 1:152 S LASKY DR STE 208
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1716
Practice Address - Country:US
Practice Address - Phone:818-795-5206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health