Basic Information
| Provider Information | |||||||||
| NPI: | 1548772593 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AIDS HEALTH FOUNDATION | ||||||||
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| OtherOrganizationName: | AHF MOBILE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8390 CHAMPIONS GATE BLVD STE 215 | ||||||||
| Address2: | |||||||||
| City: | CHAMPIONS GATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338968310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214011364 | ||||||||
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| Practice Location | |||||||||
| Address1: | 766 LAKELAND DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013683440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2017 | ||||||||
| LastUpdateDate: | 10/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | STIDHAM | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF, MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3234365019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.