Basic Information
| Provider Information | |||||||||
| NPI: | 1790163186 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCALISTER INSTITUTE FOR TREATMENT AND EDUCATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 N JOHNSON AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920201650 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3923 WARING RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194420277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | MCALISTER | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6194420277 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH COASTAL TEEN RECOVERY CENTER | ||||||||
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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 |