Provider Demographics
NPI:1962883371
Name:A PLUS ALLIANCE HOME CARE AGENCY, LLC
Entity type:Organization
Organization Name:A PLUS ALLIANCE HOME CARE AGENCY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-222-5317
Mailing Address - Street 1:5470 E BUSCH BLVD SUITE 425
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:727-222-5317
Mailing Address - Fax:813-762-1333
Practice Address - Street 1:1503 SOUTH HWY 301 SUITE 13
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619
Practice Address - Country:US
Practice Address - Phone:727-222-5317
Practice Address - Fax:813-762-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 320900000X
FL233771253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014399800Medicaid