MEDICARE: AIDS HEALTHCARE FOUNDATION

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	261QH0100X	Health Service Clinic/Center	G011429001A	FL

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

General Provider Information

NPI Number	:	1679557201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDS HEALTHCARE FOUNDATION

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	833-241-7615

Provider Business Practice Location Address
First Line	:	2 SHIRCLIFF WAY
Second Line	:	SUITE 900
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3812
Country	:	US
Telephone Number	:	904-381-9651
Fax Number	:	904-389-9319

Authorized Official
Title or Position	:	CHIEF, MANAGED CARE
Name	:	DONNA STIDHAM
Credential	:
Telephone Number	:	323-436-5025

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	09/11/2019

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Directions to “AIDS HEALTHCARE FOUNDATION ” Practice Location

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