1558479568 NPI number — ALLIANCE HEALTH CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558479568 NPI number — ALLIANCE HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HIGHLAND PARK CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558479568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69301-0950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-762-2525
Provider Business Mailing Address Fax Number:
308-762-2528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1633 SWEETWATER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69301-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-762-2525
Provider Business Practice Location Address Fax Number:
308-762-2528
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VETTER
Authorized Official First Name:
JACK
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-895-3932

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  044002 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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