Healthcare Provider Details

I. General information

NPI: 1093662413
Provider Name (Legal Business Name): LILY-ROSE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3482 HYDE PARK WAY
TALLAHASSEE FL
32309-8206
US

IV. Provider business mailing address

3482 HYDE PARK WAY
TALLAHASSEE FL
32309-8206
US

V. Phone/Fax

Practice location:
  • Phone: 850-345-6666
  • Fax:
Mailing address:
  • Phone: 850-345-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE GRANT
Title or Position: EXECUTIVE DIRECTOR
Credential: OT
Phone: 850-345-6666