Provider Demographics
NPI:1790526986
Name:ALLIANCE WELLCARE PLLC
Entity type:Organization
Organization Name:ALLIANCE WELLCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:EBHO
Authorized Official - Last Name:OSEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:781-249-8007
Mailing Address - Street 1:240 BEAR HILL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1026
Mailing Address - Country:US
Mailing Address - Phone:781-249-8007
Mailing Address - Fax:
Practice Address - Street 1:240 BEAR HILL RD STE 104
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1026
Practice Address - Country:US
Practice Address - Phone:781-249-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty