Provider Demographics
NPI:1659531689
Name:ALCONAR RESTORATION MINISTRIES, INC.
Entity Type:Organization
Organization Name:ALCONAR RESTORATION MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-995-0211
Mailing Address - Street 1:4286 WOODBINE RD
Mailing Address - Street 2:STE: A&B
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8782
Mailing Address - Country:US
Mailing Address - Phone:850-995-0211
Mailing Address - Fax:850-995-0212
Practice Address - Street 1:1400 BELL CREEK RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-9775
Practice Address - Country:US
Practice Address - Phone:850-995-7317
Practice Address - Fax:850-995-7318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFAITH BASE324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility