Provider Demographics
NPI:1093952921
Name:ALTERNATIVE BEHAVIORAL CONCEPTS, INC.
Entity Type:Organization
Organization Name:ALTERNATIVE BEHAVIORAL CONCEPTS, INC.
Other - Org Name:ABC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-206-7000
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-1057
Mailing Address - Country:US
Mailing Address - Phone:863-551-3300
Mailing Address - Fax:863-551-3301
Practice Address - Street 1:202 HOWARD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3431
Practice Address - Country:US
Practice Address - Phone:863-551-3300
Practice Address - Fax:863-551-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL677186696251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL675822396OtherMEDWAIVER
FL675822398OtherMEDWAIVER