Provider Demographics
NPI:1679000301
Name:A PLUS ALLIANCE SUPPORT CARE SERVICES, INC
Entity type:Organization
Organization Name:A PLUS ALLIANCE SUPPORT CARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-698-8884
Mailing Address - Street 1:5470 E BUSCH BLVD
Mailing Address - Street 2:SUITE 425
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5418
Mailing Address - Country:US
Mailing Address - Phone:888-698-8884
Mailing Address - Fax:813-762-1333
Practice Address - Street 1:1503 S US HIGHWAY 301
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5126
Practice Address - Country:US
Practice Address - Phone:888-698-8884
Practice Address - Fax:813-762-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017374600Medicaid