Healthcare Provider Details

I. General information

NPI: 1356632145
Provider Name (Legal Business Name): REFLECTIONS OF JUPITER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SW10 TH STREET
BELLE GLADE FL
33430
US

IV. Provider business mailing address

306 SW 10TH ST
BELLE GLADE FL
33430-3282
US

V. Phone/Fax

Practice location:
  • Phone: 561-721-4699
  • Fax:
Mailing address:
  • Phone: 561-721-4699
  • Fax: 561-844-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9160
License Number StateFL

VIII. Authorized Official

Name: MS. BRENDA MARIE GRIPPALDI
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 561-721-4699