Provider Demographics
NPI:1356481568
Name:ALLIANCE LONG TERM CARE CONSULTING, LLC
Entity Type:Organization
Organization Name:ALLIANCE LONG TERM CARE CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-993-2841
Mailing Address - Street 1:3720 W PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3325
Mailing Address - Country:US
Mailing Address - Phone:270-993-2841
Mailing Address - Fax:
Practice Address - Street 1:3720 W PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3325
Practice Address - Country:US
Practice Address - Phone:270-993-2841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty