Provider Demographics
NPI:1659955797
Name:HIDDEN OAKS ALF, INC
Entity Type:Organization
Organization Name:HIDDEN OAKS ALF, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-938-2097
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32053-0180
Mailing Address - Country:US
Mailing Address - Phone:386-938-2097
Mailing Address - Fax:386-487-0366
Practice Address - Street 1:7150 NW 22ND DR
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:FL
Practice Address - Zip Code:32053-2367
Practice Address - Country:US
Practice Address - Phone:386-938-2097
Practice Address - Fax:386-487-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)