1659531689 NPI number — ALCONAR RESTORATION MINISTRIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659531689 NPI number — ALCONAR RESTORATION MINISTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCONAR RESTORATION MINISTRIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659531689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4286 WOODBINE RD
Provider Second Line Business Mailing Address:
STE: A&B
Provider Business Mailing Address City Name:
PACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32571-8782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-995-0211
Provider Business Mailing Address Fax Number:
850-995-0212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 BELL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32565-9775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-995-7317
Provider Business Practice Location Address Fax Number:
850-995-7318
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMONS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
850-995-0211

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  FAITH BASE , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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