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General NPI Number Information
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NPI Number | 1457318461
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Entity Type | Organization
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Legal Business Name | ALLIANCE FOUNDATION OF FLORIDA INC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 595 N WILLIAMSON BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-7185
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Country | US
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Telephone | 386-257-4400
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Fax | 386-257-4372
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Provider Business Mailing Address
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Address Line | 595 N WILLIAMSON BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-7185
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Country | US
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Telephone | 386-257-4400
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Fax | 386-257-4372
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RANDOLPH L KERNON II
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Credential | LNHA
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Telephone | 386-257-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL5400
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1248096
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License Number State | FL
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