Provider Demographics
NPI:1164115952
Name:ALLIANCE BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:ALLIANCE BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAWFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-802-1717
Mailing Address - Street 1:4515 S LAKESHORE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7048
Mailing Address - Country:US
Mailing Address - Phone:480-590-6558
Mailing Address - Fax:480-590-6559
Practice Address - Street 1:6102 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1740
Practice Address - Country:US
Practice Address - Phone:225-802-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness