Provider Demographics
NPI:1265103980
Name:ALLIANCE ASSISTED LIVING HOME LLC
Entity type:Organization
Organization Name:ALLIANCE ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-592-0739
Mailing Address - Street 1:3352 E ZION WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5176
Mailing Address - Country:US
Mailing Address - Phone:480-748-4043
Mailing Address - Fax:480-748-4044
Practice Address - Street 1:3352 E ZION WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5176
Practice Address - Country:US
Practice Address - Phone:480-748-4043
Practice Address - Fax:480-748-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility