MEDICARE: ALLEGIANT ASSISTANT HOMECARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker
2	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063046332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANT ASSISTANT HOMECARE INC

Provider Business Mailing Address
First Line	:	121 DOGWOOD DRIVE LOOP
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34472-5667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 DOGWOOD DRIVE LOOP
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34472-5667
Country	:	US
Telephone Number	:	352-512-2813
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	NAKIA LYNELL SMITH
Credential	:
Telephone Number	:	352-512-2813

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	09/30/2021

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Directions to “ALLEGIANT ASSISTANT HOMECARE INC ” Practice Location

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