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General NPI Number Information
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NPI Number | 1275065112
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Entity Type | Organization
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Legal Business Name | ALLIANCE HOME CARE SERVICES, LLC.
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 11750 CANAL ST UNIT 3-506
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City | MIRAMAR
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State | FL
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Zip | 33025-7817
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Country | US
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Telephone | 866-616-0715
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Fax | 866-864-9352
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Provider Business Mailing Address
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Address Line | 11750 CANAL ST UNIT 3-506
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City | MIRAMAR
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State | FL
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Zip | 33025-7817
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Country | US
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Telephone | 866-616-0715
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Fax | 866-864-9352
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. DONTAVIUS MONQUEZ LOGAN
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Credential |
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Telephone | 786-779-4726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 234700
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 234700
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License Number State | FL
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