Provider Demographics
NPI:1649610510
Name:FRESH HORIZONS ALF
Entity type:Organization
Organization Name:FRESH HORIZONS ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-1963
Mailing Address - Street 1:4836 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-1172
Mailing Address - Country:US
Mailing Address - Phone:772-564-7271
Mailing Address - Fax:772-567-8361
Practice Address - Street 1:4836 35TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-1172
Practice Address - Country:US
Practice Address - Phone:772-564-7271
Practice Address - Fax:772-567-8361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10323172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL10323OtherACHCA
FL002968400OtherMEDICARE
FL100319687OtherLICENCE