Provider Demographics
NPI:1407321938
Name:ALLIANCE AMBULANCE LLC
Entity Type:Organization
Organization Name:ALLIANCE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-901-9954
Mailing Address - Street 1:1945 TRAFALGER DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4986
Mailing Address - Country:US
Mailing Address - Phone:630-901-9954
Mailing Address - Fax:630-824-0885
Practice Address - Street 1:4248 BELLE AIRE LANE SUITE 3
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1303
Practice Address - Country:US
Practice Address - Phone:630-901-9954
Practice Address - Fax:630-824-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport