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General NPI Number Information
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NPI Number | 1427030253
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Entity Type | Organization
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Legal Business Name | FLORIDA PREFERRED CARE DEVELOPMENTAL CENTERS I, INC.
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 2975 GARDEN ST
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City | N FT MYERS
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State | FL
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Zip | 33917-1883
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Country | US
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Telephone | 239-995-5833
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Fax | 239-995-4856
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Provider Business Mailing Address
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Address Line | 5420 W PLANO PKWY
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City | PLANO
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State | TX
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Zip | 75093-4823
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Country | US
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Telephone | 972-931-3800
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Fax | 972-767-6222
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Authorized Official
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Title or Position | DIRECTOR OF REIMBURSEMENT
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Name | MRS. JAMIE LATTURE COLLIER
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Credential |
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Telephone | 972-931-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 4071095
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License Number State | FL
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