Provider Demographics
NPI:1780218180
Name:ALICIA'S LLC
Entity Type:Organization
Organization Name:ALICIA'S LLC
Other - Org Name:BALANCED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:801-856-4734
Mailing Address - Street 1:6798 CROSSWINDS DR N STE C102
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5477
Mailing Address - Country:US
Mailing Address - Phone:801-856-4734
Mailing Address - Fax:
Practice Address - Street 1:6798 CROSSWINDS DR N STE C102
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5477
Practice Address - Country:US
Practice Address - Phone:801-856-4734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain