MEDICARE: MELISSA'S PLACE INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	9263	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942661020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA'S PLACE INC.

Provider Business Mailing Address
First Line	:	711 CLEVELAND AVE
Second Line	:
City	:	WILDWOOD
State	:	FL
Zip	:	34785-3502
Country	:	US
Telephone Number	:	352-399-6862
Fax Number	:	352-399-6863

Provider Business Practice Location Address
First Line	:	711 CLEVELAND AVE
Second Line	:
City	:	WILDWOOD
State	:	FL
Zip	:	34785-3502
Country	:	US
Telephone Number	:	352-399-6862
Fax Number	:	352-399-6863

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA WILKES
Credential	:
Telephone Number	:	352-399-6862

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	03/16/2016

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Directions to “MELISSA'S PLACE INC. ” Practice Location

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