Basic Information
| Provider Information | |||||||||
| NPI: | 1164605242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE CHILDREN'S & ALLIED HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 E 3RD ST | ||||||||
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| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693013826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087611151 | ||||||||
| FaxNumber: | 3087611139 | ||||||||
| Practice Location | |||||||||
| Address1: | 2091 BOX BUTTE AVENUE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693014457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087611151 | ||||||||
| FaxNumber: | 3087626657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | GRANT | ||||||||
| AuthorizedOfficialFirstName: | JANELL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3087611151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 10025582600 | 05 | NE | MEDICAID |