Healthcare Provider Details

I. General information

NPI: 1942661020
Provider Name (Legal Business Name): MELISSA'S PLACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CLEVELAND AVE
WILDWOOD FL
34785-3502
US

IV. Provider business mailing address

711 CLEVELAND AVE
WILDWOOD FL
34785-3502
US

V. Phone/Fax

Practice location:
  • Phone: 352-399-6862
  • Fax: 352-399-6863
Mailing address:
  • Phone: 352-399-6862
  • Fax: 352-399-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9263
License Number StateFL

VIII. Authorized Official

Name: MELISSA WILKES
Title or Position: OWNER
Credential:
Phone: 352-399-6862