Provider Demographics
NPI:1720387673
Name:ELDER CARE OF ALACHUA COUNTY INC.
Entity Type:Organization
Organization Name:ELDER CARE OF ALACHUA COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CLARIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-265-9243
Mailing Address - Street 1:3515 NW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5008
Mailing Address - Country:US
Mailing Address - Phone:352-265-0789
Mailing Address - Fax:
Practice Address - Street 1:3515 NW 98TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5008
Practice Address - Country:US
Practice Address - Phone:352-265-0789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5638251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025079102Medicaid