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General NPI Number Information
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NPI Number | 1902309156
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Entity Type | Organization
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Legal Business Name | ALLIANCE PCS
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 1655 1ST ST
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4305
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Country | US
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Telephone | 208-552-0249
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5544
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Country | US
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Telephone | 208-552-0249
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRAD STAUFFER
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Credential |
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Telephone | 208-552-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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