Provider Demographics
NPI:1275178402
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:MRS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:734-635-3499
Mailing Address - Street 1:8752 LILLY DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9655
Mailing Address - Country:US
Mailing Address - Phone:734-635-3499
Mailing Address - Fax:
Practice Address - Street 1:8752 LILLY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9655
Practice Address - Country:US
Practice Address - Phone:734-635-3499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty