Provider Demographics
NPI:1598246076
Name:ALLCARE OF SOUTHWEST FLORIDA, LLC
Entity Type:Organization
Organization Name:ALLCARE OF SOUTHWEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-674-3729
Mailing Address - Street 1:2040 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3313
Mailing Address - Country:US
Mailing Address - Phone:800-674-3729
Mailing Address - Fax:
Practice Address - Street 1:2040 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3313
Practice Address - Country:US
Practice Address - Phone:800-674-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLCARE NATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023093100Medicaid