Provider Demographics
NPI:1043589914
Name:ALLIANCE - CAP SERVICES
Entity Type:Organization
Organization Name:ALLIANCE - CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-652-1955
Mailing Address - Street 1:1710 TROTTERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28163-9306
Mailing Address - Country:US
Mailing Address - Phone:704-652-1955
Mailing Address - Fax:704-909-2701
Practice Address - Street 1:301 MCCULLOUGH DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3310
Practice Address - Country:US
Practice Address - Phone:704-652-1955
Practice Address - Fax:704-909-2701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE HEALTH AND HOMECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4366251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419064Medicaid