Provider Demographics
NPI:1275953648
Name:ALLIANCE COMMUNITY CLINIC
Entity Type:Organization
Organization Name:ALLIANCE COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-769-5756
Mailing Address - Street 1:16005 INTERNATIONAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2651
Mailing Address - Country:US
Mailing Address - Phone:206-569-5756
Mailing Address - Fax:
Practice Address - Street 1:16005 INTERNATIONAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-2651
Practice Address - Country:US
Practice Address - Phone:206-569-5756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602181252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty