1962883371 NPI number — A PLUS ALLIANCE HOME CARE AGENCY, LLC

Table of content: (NPI 1962883371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962883371 NPI number — A PLUS ALLIANCE HOME CARE AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PLUS ALLIANCE HOME CARE AGENCY, LLC
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:
LATASHA WALTERS JACKSON
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:
1962883371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5470 E BUSCH BLVD SUITE 425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-222-5317
Provider Business Mailing Address Fax Number:
813-762-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 SOUTH HWY 301 SUITE 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-222-5317
Provider Business Practice Location Address Fax Number:
813-762-1333
Provider Enumeration Date:
06/11/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALTERS JACKSON
Authorized Official First Name:
LATASHA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
727-222-5317

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 233771 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 014399800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".