Provider Demographics
NPI:1487772216
Name:ALACHUA COUNTY ORGANIZATION FOR RURAL NEEDS, INC.
Entity type:Organization
Organization Name:ALACHUA COUNTY ORGANIZATION FOR RURAL NEEDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-485-1133
Mailing Address - Street 1:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:904-824-4990
Mailing Address - Fax:904-824-2226
Practice Address - Street 1:23320 N STATE ROAD 235
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-5266
Practice Address - Country:US
Practice Address - Phone:352-485-1133
Practice Address - Fax:352-485-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98392OtherFLORIDA BLUE
FL060245101Medicaid
FL103911Medicare PIN