| Alisa Grove Pa | |
|
4408 Bedford Way Leesburg FL 34748-1321 | |
| (407) 421-2031 | |
| (407) 604-6497 |
| Full Name | Alisa Grove Pa |
|---|---|
| Speciality | Counselor |
| Location | 4408 Bedford Way, Leesburg, Florida |
| Authorized Official Name and Position | Alisa Grove (OWNER/ PRESIDENT) |
| Authorized Official Contact | 4074212031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alisa Grove Pa 4408 Bedford Way Leesburg FL 34748-1321 Ph: (407) 421-2031 | Alisa Grove Pa 4408 Bedford Way Leesburg FL 34748-1321 Ph: (407) 421-2031 |
| NPI Number | 1124635081 |
|---|---|
| Provider Enumeration Date | 09/24/2020 |
| Last Update Date | 05/30/2024 |
| Certification Date | 05/30/2024 |
| Medicare PECOS PAC ID | 6507200235 |
|---|---|
| Medicare Enrollment ID | O20240221000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124635081 | NPI | - | NPPES |
| 122073300 | Medicaid | FL |
| Provider Name | Alisa D Grove |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982986733 PECOS PAC ID: 7315381043 Enrollment ID: I20240221000808 |
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