Provider Demographics
NPI:1447519384
Name:ALANO HOUSE
Entity type:Organization
Organization Name:ALANO HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCP CACIII SMC
Authorized Official - Phone:719-520-1732
Mailing Address - Street 1:1020 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7125
Mailing Address - Country:US
Mailing Address - Phone:719-520-1732
Mailing Address - Fax:719-473-8120
Practice Address - Street 1:1020 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7125
Practice Address - Country:US
Practice Address - Phone:719-520-1732
Practice Address - Fax:719-473-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1683-00251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health