Provider Demographics
NPI:1699826321
Name:AIDS RESOURCE COUNCIL OF SOUTHWEST FLORIDA INC
Entity Type:Organization
Organization Name:AIDS RESOURCE COUNCIL OF SOUTHWEST FLORIDA INC
Other - Org Name:THE BOB RAUSCHENBERG CENTER FOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-278-4272
Mailing Address - Street 1:3677 CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8226
Mailing Address - Country:US
Mailing Address - Phone:239-278-4272
Mailing Address - Fax:239-936-6634
Practice Address - Street 1:3677 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8226
Practice Address - Country:US
Practice Address - Phone:239-278-4272
Practice Address - Fax:239-936-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27792207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty