Provider Demographics
NPI:1265909287
Name:ALAS FAMILY SUPPORT CENTER INC
Entity type:Organization
Organization Name:ALAS FAMILY SUPPORT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:772-248-2291
Mailing Address - Street 1:16652 SW WARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34956-4407
Mailing Address - Country:US
Mailing Address - Phone:772-248-2291
Mailing Address - Fax:772-248-2298
Practice Address - Street 1:16652 SW WARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-4407
Practice Address - Country:US
Practice Address - Phone:772-248-2291
Practice Address - Fax:772-248-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL717325Medicaid