Provider Demographics
NPI:1699286427
Name:ALLI CENTER LLC
Entity type:Organization
Organization Name:ALLI CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AND BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-804-9312
Mailing Address - Street 1:1150 5TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2933
Mailing Address - Country:US
Mailing Address - Phone:319-804-9312
Mailing Address - Fax:888-892-7959
Practice Address - Street 1:1150 5TH ST STE 270
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2933
Practice Address - Country:US
Practice Address - Phone:319-804-9312
Practice Address - Fax:319-449-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081108101YM0800X
IA0075821041C0700X
IA75301041C0700X
IA066701041C0700X
IA000360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0710977Medicaid
IA1881993160Medicaid