MEDICARE: ALLIANCE FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	5495C	NV

General Provider Information

NPI Number	:	1164660163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE FAMILY SERVICES

Provider Business Mailing Address
First Line	:	3435 W CRAIG RD
Second Line	:	SUITE A
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5115
Country	:	US
Telephone Number	:	702-750-0377
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 W CRAIG RD
Second Line	:	SUITE A
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5115
Country	:	US
Telephone Number	:	702-750-0377
Fax Number	:

Authorized Official
Title or Position	:	QMHP
Name	:	MISS NICOLE CHUCKALINE O'HARTZ
Credential	:	LCSW
Telephone Number	:	702-750-0377

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	01/29/2009

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