Provider Demographics
NPI:1043804180
Name:ALLIANCE HEALTHCARE & WELLNESS,LLC
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE & WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-262-5185
Mailing Address - Street 1:21401 CORKSCREW VILLAGE LN STE 1
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-1915
Mailing Address - Country:US
Mailing Address - Phone:727-309-1412
Mailing Address - Fax:
Practice Address - Street 1:21401 CORKSCREW VILLAGE LN STE 1
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-1915
Practice Address - Country:US
Practice Address - Phone:727-309-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty