Provider Demographics
NPI:1770020190
Name:INTEQ ALLIANCE, INC.
Entity Type:Organization
Organization Name:INTEQ ALLIANCE, INC.
Other - Org Name:ALBANY PREMIUM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:AKINNUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-603-1968
Mailing Address - Street 1:1737 PINEKNOLL LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3778
Mailing Address - Country:US
Mailing Address - Phone:229-603-1968
Mailing Address - Fax:229-432-0671
Practice Address - Street 1:1737 PINEKNOLL LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3778
Practice Address - Country:US
Practice Address - Phone:229-603-1968
Practice Address - Fax:229-432-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAB16-000628251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management