Basic Information
| Provider Information | |||||||||
| NPI: | 1114338035 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MCALISTER INSTITUTE FOR TREATMENT & EDUCATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL SOUTH EAST TEEN RECOVERY CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 N JOHNSON AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920201651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194420277 | ||||||||
| FaxNumber: | 6194421101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 N JOHNSON AVE | ||||||||
| Address2: | 101 | ||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920201650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194420277 | ||||||||
| FaxNumber: | 6194421101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCALISTER | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6194420277 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 0000 | 05 | CA | MEDICAID |