NPIMap

Organization Active NPI

Alliance Foundation of Florida Inc

  • Assisted Living Facility
  • Daytona Beach, FL
National Provider Identifier
1952720294
Registry record updated Apr 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL5400 Issued in FL
Legal business name
ALLIANCE FOUNDATION OF FLORIDA INC
Doing business as
INdigo Manor Assisted Living
Practice address
595 N Williamson Blvd
Daytona Beach, FL 32114-7185
Phone
(386) 257-4400
Fax
(386) 257-4372
NPI assigned
Apr 15, 2014
Organization subpart
Yes
Parent organization
ALLIANCE FOUNDATION OF FLORIDA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Randolph Lee Kernon II, NHA
Title
Executive Director
Phone
(386) 547-4686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL5400 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 1

IdentifierTypeStateIssuer
AL5400OtherFLSTATE OF FLORIDA AHCA

Other names 1

  • INdigo Manor Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alliance Foundation of Florida-Indigo Manor LLC2 organizations share this tax ID, including this one
Part of
Alliance Foundation of Florida-Indigo Manor LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397520000000",
    "number": "1952720294",
    "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": "ALLIANCE FOUNDATION OF FLORIDA INC",
        "enumeration_date": "2014-04-15",
        "last_updated": "2014-04-15",
        "status": "A",
        "authorized_official_last_name": "KERNON",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "386-547-4686",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL5400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA AHCA",
            "identifier": "AL5400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INdigo Manor Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 15, 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.

Verify at the official NPI Registry.