Provider Demographics
NPI:1720223738
Name:ALLIANCE SERVICE ORGANIZATION
Entity Type:Organization
Organization Name:ALLIANCE SERVICE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT TNPHA
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-276-1387
Mailing Address - Street 1:6100 WESTERN PL
Mailing Address - Street 2:500
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4600
Mailing Address - Country:US
Mailing Address - Phone:800-276-1387
Mailing Address - Fax:
Practice Address - Street 1:6100 WESTERN PL
Practice Address - Street 2:500
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4600
Practice Address - Country:US
Practice Address - Phone:800-276-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS NON PROFIT HOSPICE ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based