Provider Demographics
NPI:1043584303
Name:AIDS HEALTHCARE FOUNDATION
Entity Type:Organization
Organization Name:AIDS HEALTHCARE FOUNDATION
Other - Org Name:AHF-MCO OF FLORIDA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-436-5025
Mailing Address - Street 1:1001 N MARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6611
Mailing Address - Country:US
Mailing Address - Phone:323-436-5019
Mailing Address - Fax:323-337-9142
Practice Address - Street 1:110 SE 6TH ST
Practice Address - Street 2:SUITE 1960
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-5000
Practice Address - Country:US
Practice Address - Phone:954-522-3132
Practice Address - Fax:954-522-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization