Healthcare Provider Details

I. General information

NPI: 1255048641
Provider Name (Legal Business Name): ALABASTER BOX CENTER OF SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 NE 16TH PL
OCALA FL
34470-8018
US

IV. Provider business mailing address

4640 NE 16TH PL
OCALA FL
34470-8018
US

V. Phone/Fax

Practice location:
  • Phone: 352-207-5388
  • Fax:
Mailing address:
  • Phone: 352-207-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL CARR SANCHO
Title or Position: BEHAVIOR ANALYST
Credential: MED, BCBA
Phone: 352-207-5388