Provider Demographics
NPI:1043798895
Name:ALLENGIANCE COMPANION CARE LLC
Entity Type:Organization
Organization Name:ALLENGIANCE COMPANION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYRESE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-663-4869
Mailing Address - Street 1:4704 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1734
Mailing Address - Country:US
Mailing Address - Phone:912-663-4869
Mailing Address - Fax:
Practice Address - Street 1:4704 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1734
Practice Address - Country:US
Practice Address - Phone:912-663-4869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care