Provider Demographics
NPI:1376009928
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:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAWFORD
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-802-1717
Mailing Address - Street 1:4645 S LAKESHORE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7152
Mailing Address - Country:US
Mailing Address - Phone:225-802-1717
Mailing Address - Fax:
Practice Address - Street 1:230 E FRANCES LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1975
Practice Address - Country:US
Practice Address - Phone:225-802-1717
Practice Address - Fax:480-840-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness