Provider Demographics
NPI:1871917054
Name:FLORIDA COMMUNITY ALLIANCE, INC.
Entity type:Organization
Organization Name:FLORIDA COMMUNITY ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-904-6514
Mailing Address - Street 1:1870 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8901
Mailing Address - Country:US
Mailing Address - Phone:561-904-6514
Mailing Address - Fax:
Practice Address - Street 1:1870 FOREST HILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8901
Practice Address - Country:US
Practice Address - Phone:561-904-6514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063768307Medicaid
FL1912956384Medicaid
FL1336441401Medicaid