Provider Demographics
NPI:1013572304
Name:ALF 8860 ADRD TRAINING PROVIDER LLC.
Entity Type:Organization
Organization Name:ALF 8860 ADRD TRAINING PROVIDER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-379-7359
Mailing Address - Street 1:7990 BAYMEADOWS RD E UNIT 1001
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2977
Mailing Address - Country:US
Mailing Address - Phone:904-379-7359
Mailing Address - Fax:904-379-7359
Practice Address - Street 1:7990 BAYMEADOWS RD E UNIT 1001
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2977
Practice Address - Country:US
Practice Address - Phone:904-379-7359
Practice Address - Fax:904-379-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty