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General NPI Number Information
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NPI Number | 1083532253
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Entity Type | Organization
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Legal Business Name | CHIPOLA RESIDENTIAL REHABILITATIVE SERVICES
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 2419 FAIRVIEW RD
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City | MARIANNA
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State | FL
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Zip | 32448-2629
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Country | US
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Telephone | 850-526-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 FAIRVIEW RD
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City | MARIANNA
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State | FL
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Zip | 32448-2629
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Country | US
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Telephone | 850-526-0027
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EMILY TILLMAN
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Credential | MANAGER
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Telephone | 850-354-0017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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