Provider Demographics
NPI:1194012526
Name:ALLIANCE PERSONAL CARE SERVICE LLC
Entity Type:Organization
Organization Name:ALLIANCE PERSONAL CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-222-2805
Mailing Address - Street 1:10116 BAXTER CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4717
Mailing Address - Country:US
Mailing Address - Phone:704-222-2805
Mailing Address - Fax:704-943-0547
Practice Address - Street 1:705 S WELDON ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3967
Practice Address - Country:US
Practice Address - Phone:704-222-2805
Practice Address - Fax:704-943-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4470253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602326Medicaid