Healthcare Provider Details

I. General information

NPI: 1033517289
Provider Name (Legal Business Name): ALLIANCE FOR COMMUNITY TRANSFORMATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HIGHWAY 49 NORTH
MARIPOSA CA
95338-2075
US

IV. Provider business mailing address

PO BOX 2075
MARIPOSA CA
95338-2075
US

V. Phone/Fax

Practice location:
  • Phone: 209-742-6456
  • Fax: 209-742-6450
Mailing address:
  • Phone: 209-742-6456
  • Fax: 209-742-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. ALISON E TUDOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 209-742-6456