1235485012 NPI number — ALLIANCE INDIVIDUAL & FAMILY SERVICES

Table of content: (NPI 1235485012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235485012 NPI number — ALLIANCE INDIVIDUAL & FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE INDIVIDUAL & FAMILY SERVICES
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:
Provider Other Organization Name Type Code:
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:
1235485012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16513
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53216-0513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-355-5594
Provider Business Mailing Address Fax Number:
414-751-5166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 W BROWN DEER RD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53223-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-355-5594
Provider Business Practice Location Address Fax Number:
414-751-5166
Provider Enumeration Date:
07/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
ALFREDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
414-355-5594

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2975 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2975 . This is a "DEPARTMENT OF QUALITY ASSURANCE CERTIFICATION" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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