Healthcare Provider Details

I. General information

NPI: 1376613463
Provider Name (Legal Business Name): DISC VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 10TH ST
APALACHICOLA FL
32320-2103
US

IV. Provider business mailing address

3333 W PENSACOLA ST
TALLAHASSEE FL
32304-2888
US

V. Phone/Fax

Practice location:
  • Phone: 850-575-4388
  • Fax: 850-576-3317
Mailing address:
  • Phone: 850-575-4388
  • Fax: 850-576-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MELISSA SKIPTON
Title or Position: QA DIRECTOR
Credential:
Phone: 850-766-1251