MEDICARE: PUTNAM COUNTY ALCOHOL & DRUG COUNCIL, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	324500000X	Substance Abuse Rehabilitation Facility	0354AD252601	FL
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38327	OTHER	FL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	335268	OTHER	FL	VALUE OPTIONS
4	60023030	OTHER	FL	MAGELLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	274738	OTHER	FL	WELLCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1023013729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUTNAM COUNTY ALCOHOL & DRUG COUNCIL, INC.

Provider Business Mailing Address
First Line	:	330 KAY LARKIN DR
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-2307
Country	:	US
Telephone Number	:	386-329-3780
Fax Number	:	386-385-1269

Provider Business Practice Location Address
First Line	:	330 KAY LARKIN DR
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-2307
Country	:	US
Telephone Number	:	386-329-3780
Fax Number	:	386-385-1269

Authorized Official
Title or Position	:	CHAIRPERSON BOARD OF DIRECTORS
Name	:	MRS. JOYCE C MILLER
Credential	:
Telephone Number	:	386-325-4714

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/29/2011

320 KAY LARKIN DR
PALATKA, FL
32177-2307

Practice Phone: 800-539-4228
Practice Fax: