Healthcare Provider Details

I. General information

NPI: 1548225782
Provider Name (Legal Business Name): THE CENTER FOR INDEPENDENT LIVING OF NORTH FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 BUFORD CT
TALLAHASSEE FL
32308-4465
US

IV. Provider business mailing address

1823 BUFORD CT
TALLAHASSEE FL
32308-4465
US

V. Phone/Fax

Practice location:
  • Phone: 850-575-9621
  • Fax: 850-575-5740
Mailing address:
  • Phone: 850-575-9621
  • Fax: 850-575-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL W MOORE
Title or Position: DIRECTOR, PROGRAMS AND SERVICES
Credential: LMHC
Phone: 850-575-9621