Provider Demographics
NPI:1548503550
Name:ALICIA DIANE MARSH CONNECTIONS FOR SENIORS
Entity type:Organization
Organization Name:ALICIA DIANE MARSH CONNECTIONS FOR SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-486-8394
Mailing Address - Street 1:4241 ACLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286
Mailing Address - Country:US
Mailing Address - Phone:941-486-8394
Mailing Address - Fax:941-485-6451
Practice Address - Street 1:4241 ACLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286
Practice Address - Country:US
Practice Address - Phone:941-486-8394
Practice Address - Fax:941-485-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL228449253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care