Healthcare Provider Details

I. General information

NPI: 1003501032
Provider Name (Legal Business Name): ALLIANCE CARE & SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 KNIGHTDALE BLVD STE 103
KNIGHTDALE NC
27545-9015
US

IV. Provider business mailing address

4268 ROCKDELL HALL ST
RALEIGH NC
27616-8078
US

V. Phone/Fax

Practice location:
  • Phone: 919-268-3652
  • Fax:
Mailing address:
  • Phone: 919-268-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTWAND BLANKS
Title or Position: ADMINISTRATOR/DIRECTOR
Credential:
Phone: 919-268-3652