Provider Demographics
NPI:1043407596
Name:ALLIANCE LTC INVESTORS,LLC
Entity Type:Organization
Organization Name:ALLIANCE LTC INVESTORS,LLC
Other - Org Name:CROSSROADS AT ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-2063
Mailing Address - Street 1:150 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2156
Mailing Address - Country:US
Mailing Address - Phone:308-762-1615
Mailing Address - Fax:308-762-1621
Practice Address - Street 1:2415 MULLINS AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-4274
Practice Address - Country:US
Practice Address - Phone:719-589-2063
Practice Address - Fax:719-589-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF048310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1002552400Medicaid