Healthcare Provider Details

I. General information

NPI: 1003952417
Provider Name (Legal Business Name): ALTERNATE FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 W OAKLAND PARK BLVD SUITE 200
SUNRISE FL
33351-6925
US

IV. Provider business mailing address

10001 W OAKLAND PARK BLVD SUITE 200
SUNRISE FL
33351-6925
US

V. Phone/Fax

Practice location:
  • Phone: 954-746-5200
  • Fax: 954-746-5216
Mailing address:
  • Phone: 954-746-5200
  • Fax: 954-746-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberR-AFC-0906-101-6
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberR-AFC-1006-102-17
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberR-AFC-0906-100-6
License Number StateFL

VIII. Authorized Official

Name: DR. RONALD DAVID SIMON
Title or Position: CFO
Credential: EDD
Phone: 954-746-5200