Provider Demographics
NPI:1821817511
Name:ALCORN ADAPTIVE LLC
Entity type:Organization
Organization Name:ALCORN ADAPTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-218-0035
Mailing Address - Street 1:3800 E VISTA CHINO STE 4
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4010
Mailing Address - Country:US
Mailing Address - Phone:760-464-0366
Mailing Address - Fax:
Practice Address - Street 1:3800 E VISTA CHINO STE 4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4010
Practice Address - Country:US
Practice Address - Phone:760-464-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies