Provider Demographics
NPI:1780459016
Name:THE CHILD'S ALLIANCE, LLC
Entity type:Organization
Organization Name:THE CHILD'S ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:RIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PA-C
Authorized Official - Phone:801-448-8699
Mailing Address - Street 1:11721 S SILVER SPUR LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-4515
Mailing Address - Country:US
Mailing Address - Phone:801-462-3925
Mailing Address - Fax:
Practice Address - Street 1:1909 S 4250 W OFC A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-4837
Practice Address - Country:US
Practice Address - Phone:801-675-8777
Practice Address - Fax:801-852-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6833666-2501OtherDOPL
UT6833666-1206OtherDOPL
UT1134424641OtherNPPES
UT6833666-8906OtherDOPL