Provider Demographics
NPI:1912394537
Name:ALLIANCE FOUNDATION OF FLORIDA-INDIGO MANOR, LLC
Entity Type:Organization
Organization Name:ALLIANCE FOUNDATION OF FLORIDA-INDIGO MANOR, LLC
Other - Org Name:TAFFI MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-225-4700
Mailing Address - Street 1:148 CYPRESS POINT PKWY SUITE 208
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8426
Mailing Address - Country:US
Mailing Address - Phone:386-225-4700
Mailing Address - Fax:386-225-4627
Practice Address - Street 1:145 CYPRESS POINT PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8426
Practice Address - Country:US
Practice Address - Phone:386-225-4700
Practice Address - Fax:386-225-4627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE FOUNDATION OF FLORIDA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1314098332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies