Provider Demographics
NPI:1427815109
Name:ALLIANCE CARE 360
Entity type:Organization
Organization Name:ALLIANCE CARE 360
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:CABBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:312-808-1044
Mailing Address - Street 1:2929 S WABASH AVE STE 202
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:312-808-1055
Practice Address - Street 1:2929 S WABASH AVE STE 202
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:773-824-6228
Practice Address - Fax:312-808-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty