Healthcare Provider Details

I. General information

NPI: 1992132484
Provider Name (Legal Business Name): ALEMBIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8359 BEACON BLVD STE 411
FORT MYERS FL
33907-3065
US

IV. Provider business mailing address

1417 SE 24TH AVE APT C
CAPE CORAL FL
33990-1974
US

V. Phone/Fax

Practice location:
  • Phone: 239-425-2616
  • Fax: 239-236-1718
Mailing address:
  • Phone: 239-784-3741
  • Fax: 239-236-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA 1-09-5040
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 57488
License Number StateFL

VIII. Authorized Official

Name: MS. BRENDA JEANNE BAKER
Title or Position: PRESIDENT
Credential: MA, BCBA, LMT
Phone: 239-784-3741