Provider Demographics
NPI:1558390492
Name:ALLIANCE FOUNDATION OF FLORIDA-INDIGO MANOR,LLC
Entity Type:Organization
Organization Name:ALLIANCE FOUNDATION OF FLORIDA-INDIGO MANOR,LLC
Other - Org Name:TAFFI MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-916-7773
Mailing Address - Street 1:795 FENTRESS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1251
Mailing Address - Country:US
Mailing Address - Phone:386-238-1060
Mailing Address - Fax:386-238-1065
Practice Address - Street 1:795 FENTRESS BLVD STE D
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1251
Practice Address - Country:US
Practice Address - Phone:386-238-1060
Practice Address - Fax:386-238-1065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE FOUNDATION OF FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4956420001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4956420001Medicare NSC