Healthcare Provider Details

I. General information

NPI: 1790515716
Provider Name (Legal Business Name): ALLIANCE ADOLESCENT AND CHILDREN'S SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 510TH ST
MARCUS IA
51035-7123
US

IV. Provider business mailing address

239 510TH ST
MARCUS IA
51035-7123
US

V. Phone/Fax

Practice location:
  • Phone: 712-221-1027
  • Fax:
Mailing address:
  • Phone: 712-221-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KATHERINE JOCHIMS
Title or Position: OWNER
Credential: LISW
Phone: 712-221-1027