1568683894 NPI number — ALLIANCE HEALTH SERVICES, INC

Table of content: MELISSA LAUREN BEHRENS CRNA (NPI 1457380065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568683894 NPI number — ALLIANCE HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE HEALTH SERVICES, 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:
ALLIANCE HOSPICE - MISSISSIPPI
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:
1568683894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 SHELBY VIEW DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38134-7659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-516-1800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 GOODMAN RD E STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-9504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASHMAN
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-516-1400

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 770304 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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