Organization
ALLIANCE FOUNDATION OF FLORIDA INC
Active
Parent organization
ALLIANCE FOUNDATION OF FLORIDA INC
Other names
INdigo Manor Assisted Living
Organization subpart
Yes
Provider details
NPI number
Legal business name
ALLIANCE FOUNDATION OF FLORIDA INC
Authorized official
MR. RANDOLPH LEE KERNON II NHA (EXECUTIVE DIRECTOR)
(386) 547-4686
Entity
Organization
Contact information
Practice address
595 N WILLIAMSON BLVD, DAYTONA BEACH, FL 32114-7185
(386) 257-4400
(386) 257-4372
Mailing address
595 N WILLIAMSON BLVD, DAYTONA BEACH, FL 32114-7185
(386) 257-4400
(386) 257-4372
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL5400
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL5400
STATE OF FLORIDA AHCA
FL
Enumeration date
04/15/2014
Last updated
04/15/2014
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