Provider Demographics
NPI:1750094942
Name:ALLIANCE CARE 360 WELLNESS
Entity type:Organization
Organization Name:ALLIANCE CARE 360 WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:M CABBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:773-824-6228
Mailing Address - Street 1:2929 S WABASH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3243
Mailing Address - Country:US
Mailing Address - Phone:773-824-6228
Mailing Address - Fax:
Practice Address - Street 1:2929 S WABASH AVE STE 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3243
Practice Address - Country:US
Practice Address - Phone:312-808-1044
Practice Address - Fax:312-808-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty