Healthcare Provider Details

I. General information

NPI: 1154836732
Provider Name (Legal Business Name): ALLEGIANT HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 MOORE ST STE 400
HACKENSACK NJ
07601-7418
US

IV. Provider business mailing address

1165 NORTHCHASE PKWY SE STE 250
MARIETTA GA
30067-6432
US

V. Phone/Fax

Practice location:
  • Phone: 201-968-5085
  • Fax:
Mailing address:
  • Phone: 770-421-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
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: DAVID JONES
Title or Position: OWNNER
Credential:
Phone: 212-781-0101