Provider Demographics
NPI:1689211336
Name:ALLY INDEPENDENCE, LLC
Entity Type:Organization
Organization Name:ALLY INDEPENDENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CARE ADMINISTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-717-8148
Mailing Address - Street 1:9717 ELK GROVE FLORIN RD STE F
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2262
Mailing Address - Country:US
Mailing Address - Phone:800-630-6156
Mailing Address - Fax:
Practice Address - Street 1:9717 ELK GROVE FLORIN RD STE F
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2262
Practice Address - Country:US
Practice Address - Phone:800-630-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health