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General NPI Number Information
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NPI Number | 1225274582
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Entity Type | Organization
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Legal Business Name | REFLECTIONS CARE CLUB, INC
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 5711 INDEPENDENCE CIR
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City | FORT MYERS
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State | FL
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Zip | 33912-4402
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Country | US
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Telephone | 239-498-6888
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Fax | 239-466-6209
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Provider Business Mailing Address
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Address Line | 5711 INDEPENDENCE CIR
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City | FORT MYERS
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State | FL
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Zip | 33912-4402
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Country | US
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Telephone | 239-498-6888
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Fax | 239-466-6209
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Authorized Official
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Title or Position | OWNER
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Name | TARA HOOLEY-SEGO
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Credential |
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Telephone | 239-498-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9094
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License Number State | FL
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