Provider Demographics
NPI:1689016560
Name:ALTERNATE GROUP CARE, INC
Entity Type:Organization
Organization Name:ALTERNATE GROUP CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-746-5200
Mailing Address - Street 1:10001 W OAKLAND PARK BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6925
Mailing Address - Country:US
Mailing Address - Phone:954-746-5200
Mailing Address - Fax:954-746-5216
Practice Address - Street 1:20250 SW 50TH PL
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1021
Practice Address - Country:US
Practice Address - Phone:954-680-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38322D00000X
FL39322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029582509Medicaid
FL029582502Medicaid