Provider Demographics
NPI:1114153780
Name:ALLEGIANCE COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:ALLEGIANCE COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:RINAUD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-264-7517
Mailing Address - Street 1:1316 LANERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8247
Mailing Address - Country:US
Mailing Address - Phone:919-264-7517
Mailing Address - Fax:866-576-2722
Practice Address - Street 1:34 ORLEANDER DR.
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527
Practice Address - Country:US
Practice Address - Phone:919-264-7517
Practice Address - Fax:866-576-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health