Provider Demographics
NPI:1922763416
Name:MARIE A ALEXIS ADULT FAMILY CARE HOME
Entity Type:Organization
Organization Name:MARIE A ALEXIS ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:ALEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-338-7974
Mailing Address - Street 1:63 RYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6438
Mailing Address - Country:US
Mailing Address - Phone:386-338-7974
Mailing Address - Fax:386-263-7649
Practice Address - Street 1:63 RYBERRY DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6438
Practice Address - Country:US
Practice Address - Phone:386-338-7974
Practice Address - Fax:386-263-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No253Z00000XAgenciesIn Home Supportive Care