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General NPI Number Information
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NPI Number | 1871205096
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 2218 JACKSON BLVD STE 5
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City | RAPID CITY
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State | SD
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Zip | 57702-3452
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Country | US
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Telephone | 757-303-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 TODDS LN STE 240
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City | HAMPTON
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State | VA
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Zip | 23666-3197
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOMINIQUE SKINNER
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Credential |
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Telephone | 757-303-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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