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General NPI Number Information
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NPI Number | 1356632145
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Entity Type | Organization
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Legal Business Name | REFLECTIONS OF JUPITER LLC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 306 SW10 TH STREET
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City | BELLE GLADE
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State | FL
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Zip | 33430
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Country | US
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Telephone | 561-721-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 306 SW 10TH ST
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City | BELLE GLADE
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State | FL
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Zip | 33430-3282
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Country | US
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Telephone | 561-721-4699
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Fax | 561-844-0358
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BRENDA MARIE GRIPPALDI
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Credential | LPN
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Telephone | 561-721-4699
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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 | 9160
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License Number State | FL
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