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General NPI Number Information
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NPI Number | 1326699968
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Entity Type | Organization
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Legal Business Name | ALLIANCE BEHAVIORAL CARE LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 2107 E GENEVA DR
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City | TEMPE
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State | AZ
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Zip | 85282-4039
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Country | US
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Telephone | 480-590-6558
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Fax | 480-590-6559
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Provider Business Mailing Address
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Address Line | 4515 S LAKESHORE DR STE 105
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City | TEMPE
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State | AZ
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Zip | 85282-7048
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Country | US
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Telephone | 480-590-6558
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Fax | 480-590-6559
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT C BREEDLOVE
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Credential |
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Telephone | 480-590-6558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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