Provider Demographics
NPI:1710394168
Name:THE ALLIANCE COMMUNITY FOR RETIREMENT LIVING, INC.
Entity Type:Organization
Organization Name:THE ALLIANCE COMMUNITY FOR RETIREMENT LIVING, INC.
Other - Org Name:THE CENTER FOR THE ASSISTED LIVING OF THE ALLIANCE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-734-3481
Mailing Address - Street 1:600 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-5832
Mailing Address - Country:US
Mailing Address - Phone:386-734-3481
Mailing Address - Fax:386-734-2086
Practice Address - Street 1:600 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5832
Practice Address - Country:US
Practice Address - Phone:386-734-3481
Practice Address - Fax:386-734-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679337100Medicaid
FL679333900Medicaid