Provider Demographics
NPI:1447495288
Name:ANALINE, INC
Entity type:Organization
Organization Name:ANALINE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:386-734-4442
Mailing Address - Street 1:1515 COVERED BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7990
Mailing Address - Country:US
Mailing Address - Phone:386-734-4442
Mailing Address - Fax:386-734-4153
Practice Address - Street 1:1515 COVERED BRIDGE DR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7990
Practice Address - Country:US
Practice Address - Phone:386-734-4442
Practice Address - Fax:386-734-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686574700Medicaid