Healthcare Provider Details

I. General information

NPI: 1043979453
Provider Name (Legal Business Name): ALIVIA CARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 SUNBEAM RD FL 32257
JACKSONVILLE FL
32257-2425
US

IV. Provider business mailing address

4266 SUNBEAM RD FL 32257
JACKSONVILLE FL
32257-2425
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-5200
  • Fax:
Mailing address:
  • Phone: 904-268-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ANNE PONDER-STANSEL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 904-407-6362