Provider Demographics
NPI:1861747958
Name:ALLEGIANCE HEALTH
Entity type:Organization
Organization Name:ALLEGIANCE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:517-841-7878
Mailing Address - Street 1:205 N EAST AVE JACKSON
Mailing Address - Street 2:205 N EAST AVE JACKSON
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-841-7878
Mailing Address - Fax:517-817-7664
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital