Provider Demographics
NPI:1932324183
Name:ALIVIA CARE SOLUTIONS, INC.
Entity type:Organization
Organization Name:ALIVIA CARE SOLUTIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PONDER-STANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-407-6362
Mailing Address - Street 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2425
Mailing Address - Country:US
Mailing Address - Phone:904-407-5050
Mailing Address - Fax:904-407-8123
Practice Address - Street 1:3870 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5601
Practice Address - Country:US
Practice Address - Phone:352-307-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-9154OtherPTAN ( CCN)
FL113488200Medicaid