Provider Demographics
NPI:1609191857
Name:ALTERNATIVE HOMEMAKING WITH A HEART OF SW FLORIDA LLC
Entity Type:Organization
Organization Name:ALTERNATIVE HOMEMAKING WITH A HEART OF SW FLORIDA LLC
Other - Org Name:ALTERNATIVE HOMEMAKING WITH A HEART OF SW FLORIDA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR, MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-488-2248
Mailing Address - Street 1:1901 TAMIAMI TRL S
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5002
Mailing Address - Country:US
Mailing Address - Phone:941-488-2248
Mailing Address - Fax:941-488-2626
Practice Address - Street 1:1901 TAMIAMI TRL S
Practice Address - Street 2:SUITE A
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5002
Practice Address - Country:US
Practice Address - Phone:941-488-2248
Practice Address - Fax:941-488-2626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTERNATIVE HOMEMAKING WITH A HEART OF SW FLORIDA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-31
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993661251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299994159OtherALTERNATIVE HOMEMAKING WITH A HEART OF SW FLORIDA LLC PORT CHARLOTTE
FL299994159OtherALTERNATIVE HOMEMAKING WITH A HEART OF SW FLORIDA LLC PORT CHARLOTTE