Healthcare Provider Details

I. General information

NPI: 1942479258
Provider Name (Legal Business Name): ALLIANCE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 FREMONT DRIVE
LARKSPUR CO
80118-8730
US

IV. Provider business mailing address

200 S WILCOX ST SUITE 140
CASTLE ROCK CO
80104
US

V. Phone/Fax

Practice location:
  • Phone: 720-201-6959
  • Fax:
Mailing address:
  • Phone: 720-201-6959
  • Fax: 303-681-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number44470
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN203060
License Number StateCA

VIII. Authorized Official

Name: MRS. SIRENA LIVINA MCGRATH
Title or Position: VICE PRESIDENT
Credential: LPN
Phone: 303-681-9949