Provider Demographics
NPI:1922288950
Name:A.H. OF MONROE COUNTY, INC.
Entity Type:Organization
Organization Name:A.H. OF MONROE COUNTY, INC.
Other - Org Name:AIDS HELP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-296-6196
Mailing Address - Street 1:PO BOX 4374
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33041-4374
Mailing Address - Country:US
Mailing Address - Phone:305-296-6196
Mailing Address - Fax:305-296-6337
Practice Address - Street 1:1434 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4008
Practice Address - Country:US
Practice Address - Phone:305-296-6196
Practice Address - Fax:305-296-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL687670600251B00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687670600OtherMEDICAID PROVIDER NUMBER
FL080850400Medicaid