Healthcare Provider Details

I. General information

NPI: 1427808757
Provider Name (Legal Business Name): ALARICHEALTHLAKECITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 EDGEWOOD AVE S
JACKSONVILLE FL
32205-3727
US

IV. Provider business mailing address

455 EDGEWOOD AVE S
JACKSONVILLE FL
32205-3727
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-9007
  • Fax: 904-384-2899
Mailing address:
  • Phone: 904-384-9007
  • Fax: 904-384-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES C WHITED JR.
Title or Position: OWNER
Credential: APRN
Phone: 904-384-9007