Provider Demographics
NPI:1871529347
Name:ALTERCARE LLC
Entity type:Organization
Organization Name:ALTERCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-697-3606
Mailing Address - Street 1:1645 PALM BEACH LAKES BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2218
Mailing Address - Country:US
Mailing Address - Phone:561-697-3606
Mailing Address - Fax:561-697-3614
Practice Address - Street 1:12740 GRAN BAY PKWY W STE 2400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5495
Practice Address - Country:US
Practice Address - Phone:904-229-0510
Practice Address - Fax:904-229-0515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITALITY HOME CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20756096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20756096OtherFL HHA LICENSE #
FL107689Medicare UPIN
FL107689Medicare ID - Type UnspecifiedPROVIDER NUMBER