Life Alliance, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

LIFE ALLIANCE, LLC

Doing business as

Life Alliance, LLC

Practice address

8609 Lyndale Ave S, Suite 213C
Bloomigton, MN 55420-5542

Phone

(952) 777-4625

Fax

(952) 777-4627

NPI assigned

Jul 31, 2017

Last updated

Jul 31, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdisallam A AbdulleNPI 1558875856

Title

Ceo

Phone

(952) 777-4625

Specialties & licenses 4

Addresses

Other names 1

• Life Alliance, LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Abdisallam Ahmed Abdulle

  • School Counselor
  • Minneapolis, MN
  • NPI 1558875856
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1124542360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8609 LYNDALE AVE S STE 213C",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554202769",
            "telephone_number": "612-200-9466",
            "fax_number": "952-777-4627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8609 LYNDALE AVE S, SUITE 213C",
            "city": "BLOOMIGTON",
            "state": "MN",
            "postal_code": "554205542",
            "telephone_number": "952-777-4625",
            "fax_number": "952-777-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ALLIANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "ABDULLE",
        "authorized_official_first_name": "ABDISALLAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-777-4625"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "MN",
            "license": "1087364-1-HCBS",
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Alliance, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.