Active NPI
Alliance Foundation of Florida Inc
- Skilled Nursing Facility
- Daytona Beach, FL
National Provider Identifier
1457318461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- SNF1248096
- Legal business name
- ALLIANCE FOUNDATION OF FLORIDA INC
- Practice address
- 595 N Williamson Blvd
Daytona Beach, FL 32114-7185 - Phone
- (386) 257-4400
- Fax
- (386) 257-4372
- NPI assigned
- Apr 26, 2006
- Organization subpart
- Yes
- Parent organization
- ALLIANCEFOUNDATION OF FLORIDA INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Randolph L Kernon II, LNHA
- Title
- Executive Director
- Phone
- (386) 257-4400
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL5400 | FL | |
| Skilled Nursing Facility | 314000000X | SNF1248096 | FL | Primary |
Addresses
Primary practice location
595 N Williamson Blvd
Daytona Beach, FL 32114-7185
Mailing address
595 N Williamson Blvd
Daytona Beach, FL 32114-7185
Phone (386) 257-4400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 685701900 | Medicaid | FL | |
| 025875000 | Medicaid | FL |
National Provider Directory
National Provider Directory- Part of
- Alliance Foundation of Florida-Indigo Manor LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1396828800000",
"number": "1457318461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "595 N WILLIAMSON BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321147185",
"telephone_number": "386-257-4400",
"fax_number": "386-257-4372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 N WILLIAMSON BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321147185",
"telephone_number": "386-257-4400",
"fax_number": "386-257-4372"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALLIANCE FOUNDATION OF FLORIDA INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ALLIANCEFOUNDATION OF FLORIDA INC",
"enumeration_date": "2006-04-26",
"last_updated": "2014-04-07",
"status": "A",
"authorized_official_last_name": "KERNON",
"authorized_official_first_name": "RANDOLPH",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "386-257-4400",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "II",
"authorized_official_credential": "LNHA"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "FL",
"license": "AL5400",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "SNF1248096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "685701900",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "025875000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.