Healthcare Provider Details

I. General information

NPI: 1609981539
Provider Name (Legal Business Name): SUWANNEE VALLEY COMMUNITY COORDINATED CHILDCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SW COLUMBIA AVE
LAKE CITY FL
32025-7036
US

IV. Provider business mailing address

236 SW COLUMBIA AVE
LAKE CITY FL
32025-7036
US

V. Phone/Fax

Practice location:
  • Phone: 386-754-2222
  • Fax: 386-754-2220
Mailing address:
  • Phone: 386-754-2222
  • Fax: 386-754-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. MICHELE ANNE WARD
Title or Position: EXECUTIVE DIRECTOR
Credential: C.E.O.
Phone: 386-754-2222