1760731848 NPI number — FLORIDA ALF, INC

Table of content: (NPI 1760731848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760731848 NPI number — FLORIDA ALF, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA ALF, 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:
CAPE CORAL SHORES
Provider Other Organization Name Type Code:
3
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:
1760731848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-1036 WAIPIO UKA STREET
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
WAIPAHU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-676-3410
Provider Business Mailing Address Fax Number:
239-573-9424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1318 SANTA BARBARA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-573-9442
Provider Business Practice Location Address Fax Number:
239-573-9424
Provider Enumeration Date:
09/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
847-337-7955

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  AL12176 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: AL12176 , 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)