Provider Demographics
NPI:1386477735
Name:ALLIANCE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:ALLIANCE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:RACHAEL
Authorized Official - Last Name:LABBE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-480-3898
Mailing Address - Street 1:1381 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3314
Mailing Address - Country:US
Mailing Address - Phone:707-334-5494
Mailing Address - Fax:
Practice Address - Street 1:1557 HEALDSBURG AVE STE 15&16
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3260
Practice Address - Country:US
Practice Address - Phone:707-433-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)