1386908473 NPI number — ALIVIA CARE SOLUTIONS, INC.

Table of content: (NPI 1386908473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386908473 NPI number — ALIVIA CARE SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALIVIA CARE SOLUTIONS, 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:
ALLEGIANT HOME CARE
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:
1386908473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4266 SUNBEAM ROAD
Provider Second Line Business Mailing Address:
ATTN: BONNIE OVERBEY, DIRECTOR OF LEGAL & REGULATORY CO
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-407-5050
Provider Business Mailing Address Fax Number:
904-407-8123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5450 RAMONA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32205-4750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-361-3902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PONDER-STANSEL
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
904-268-5200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119558300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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