Healthcare Provider Details

I. General information

NPI: 1548971997
Provider Name (Legal Business Name): DISC VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 SW MAIN ST
GREENVILLE FL
32331-3149
US

IV. Provider business mailing address

3333 WEST PENSACOLA STREET STE. 300
TALLAHASSEE FL
32304-2888
US

V. Phone/Fax

Practice location:
  • Phone: 850-948-1231
  • Fax: 850-948-1230
Mailing address:
  • Phone: 850-575-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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