Healthcare Provider Details

I. General information

NPI: 1164605242
Provider Name (Legal Business Name): ALLIANCE CHILDREN'S & ALLIED HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 BOX BUTTE AVENUE SUITE 600
ALLIANCE NE
69301-4457
US

IV. Provider business mailing address

204 E 3RD ST
ALLIANCE NE
69301-3826
US

V. Phone/Fax

Practice location:
  • Phone: 308-761-1151
  • Fax: 308-762-6657
Mailing address:
  • Phone: 308-761-1151
  • Fax: 308-761-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANELL A GRANT
Title or Position: OWNER
Credential: ARRN
Phone: 308-761-1151