Healthcare Provider Details

I. General information

NPI: 1669258455
Provider Name (Legal Business Name): GENCARE KIDS PPEC PLUS LEARNING CENTER MELBOURNE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 PINEDA CT
MELBOURNE FL
32940-6504
US

IV. Provider business mailing address

335 PINEDA CT
MELBOURNE FL
32940-6504
US

V. Phone/Fax

Practice location:
  • Phone: 888-425-7732
  • Fax: 407-440-2876
Mailing address:
  • Phone: 888-425-7732
  • Fax: 407-440-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLIVE GAYE
Title or Position: PRESIDENT
Credential: MBA
Phone: 888-425-7732