=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184861403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE HEALTH CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2009
-----------------------------------------------------
Last Update Date | 01/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1207 E 16TH AVE STE A
-----------------------------------------------------
City | CORDELE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31015-1587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-276-0220
-----------------------------------------------------
Fax | 229-273-4666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 FOX GLOVE CT
-----------------------------------------------------
City | CATAULA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31804-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-571-3299
-----------------------------------------------------
Fax | 706-324-0765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. DONNA J DAVIS
-----------------------------------------------------
Credential | BSW, NHA
-----------------------------------------------------
Telephone | 706-571-3299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------