Provider Demographics
NPI:1205699113
Name:FAMILY ALLIANCE HEALTHCARE LLC
Entity type:Organization
Organization Name:FAMILY ALLIANCE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MR
Authorized Official - First Name:GOODIE
Authorized Official - Middle Name:OSHIAPI
Authorized Official - Last Name:ILUEBBEY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:763-221-4774
Mailing Address - Street 1:5821 CEDAR LAKE RD S UNIT H-106
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1487
Mailing Address - Country:US
Mailing Address - Phone:763-221-4774
Mailing Address - Fax:763-269-7481
Practice Address - Street 1:5821 CEDAR LAKE RD S UNIT H-106
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1487
Practice Address - Country:US
Practice Address - Phone:763-221-4774
Practice Address - Fax:763-269-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No385H00000XRespite Care FacilityRespite Care
No251J00000XAgenciesNursing Care