Healthcare Provider Details

I. General information

NPI: 1326699968
Provider Name (Legal Business Name): ALLIANCE BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 E GENEVA DR
TEMPE AZ
85282-4039
US

IV. Provider business mailing address

4515 S LAKESHORE DR STE 105
TEMPE AZ
85282-7048
US

V. Phone/Fax

Practice location:
  • Phone: 480-590-6558
  • Fax: 480-590-6559
Mailing address:
  • Phone: 480-590-6558
  • Fax: 480-590-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT C BREEDLOVE
Title or Position: CEO
Credential:
Phone: 480-590-6558