Healthcare Provider Details

I. General information

NPI: 1154184851
Provider Name (Legal Business Name): ALBA COURT DEVELOPMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 FAULKNER ST
NEW SMYRNA BEACH FL
32168-6709
US

IV. Provider business mailing address

115 WASHINGTON ST
NEW SMYRNA FL
32168-7068
US

V. Phone/Fax

Practice location:
  • Phone: 386-732-2030
  • Fax:
Mailing address:
  • Phone: 386-349-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYLANDA D POWELL
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 386-349-1515