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General NPI Number Information
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NPI Number | 1659531689
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Entity Type | Organization
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Legal Business Name | ALCONAR RESTORATION MINISTRIES, INC.
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 1400 BELL CREEK RD
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City | JAY
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State | FL
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Zip | 32565-9775
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Country | US
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Telephone | 850-995-7317
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Fax | 850-995-7318
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Provider Business Mailing Address
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Address Line | 4286 WOODBINE RD STE: A&B
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City | PACE
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State | FL
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Zip | 32571-8782
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Country | US
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Telephone | 850-995-0211
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Fax | 850-995-0212
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. JOHN R HAMMONS
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Credential |
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Telephone | 850-995-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | FAITH BASE
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License Number State | FL
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