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General NPI Number Information
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NPI Number | 1750094942
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Entity Type | Organization
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Legal Business Name | ALLIANCE CARE 360 WELLNESS
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 2929 S WABASH AVE STE 203
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City | CHICAGO
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State | IL
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Zip | 60616-3243
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Country | US
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Telephone | 312-808-1044
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Fax | 312-808-1055
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Provider Business Mailing Address
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Address Line | 2929 S WABASH AVE STE 203
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City | CHICAGO
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State | IL
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Zip | 60616-3243
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Country | US
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Telephone | 773-824-6228
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ARIQ M CABBLER
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Credential | PA
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Telephone | 773-824-6228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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