Provider Demographics
NPI:1366623050
Name:ALLIANCE FOR LIFE, LLC
Entity Type:Organization
Organization Name:ALLIANCE FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-679-6858
Mailing Address - Street 1:733 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3312
Mailing Address - Country:US
Mailing Address - Phone:317-679-6858
Mailing Address - Fax:267-821-1810
Practice Address - Street 1:733 W 44TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3312
Practice Address - Country:US
Practice Address - Phone:317-679-6858
Practice Address - Fax:267-821-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty