Provider Demographics
NPI:1568196830
Name:ALLIANCE LIFETIME MENTAL HEALTH, INC
Entity type:Organization
Organization Name:ALLIANCE LIFETIME MENTAL HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-655-7782
Mailing Address - Street 1:790 TURNPIKE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:N. ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6138
Mailing Address - Country:US
Mailing Address - Phone:978-655-7782
Mailing Address - Fax:978-655-7731
Practice Address - Street 1:790 TURNPIKE ST STE 302
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6138
Practice Address - Country:US
Practice Address - Phone:978-655-7782
Practice Address - Fax:978-655-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110076593BMedicaid