Provider Demographics
NPI:1790739670
Name:ALLIANCE CARE OF WEST FLORIDA INC
Entity Type:Organization
Organization Name:ALLIANCE CARE OF WEST FLORIDA INC
Other - Org Name:ALLIANCECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-244-0220
Mailing Address - Street 1:2400 HIGH RIDGE RD
Mailing Address - Street 2:SUITE 101 AND 103
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8725
Mailing Address - Country:US
Mailing Address - Phone:561-244-0220
Mailing Address - Fax:561-244-0222
Practice Address - Street 1:7979 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6819
Practice Address - Country:US
Practice Address - Phone:561-244-0220
Practice Address - Fax:561-244-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68-6565225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686565Medicare Oscar/Certification