Provider Demographics
NPI:1609489350
Name:ALTERNATIVE CARE GROUP LLC
Entity Type:Organization
Organization Name:ALTERNATIVE CARE GROUP LLC
Other - Org Name:ALTERNATIVE CARE GROUP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MABIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-699-0955
Mailing Address - Street 1:8761 N 56TH ST UNIT 292716
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8761 N 56TH ST UNIT 292716
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-6274
Practice Address - Country:US
Practice Address - Phone:813-699-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105396200Medicaid