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General NPI Number Information
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NPI Number | 1528112778
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Entity Type | Organization
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Legal Business Name | UNITED CEREBRAL PALSY OF N FL'S TENDER LOVE AND CARE
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1241 N EAST AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-4426
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Country | US
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Telephone | 850-769-7960
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Fax | 850-769-1060
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Provider Business Mailing Address
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Address Line | 1241 N EAST AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-4426
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Country | US
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Telephone | 850-769-7960
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Fax | 850-769-1060
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ARTHUR BREEDLOVE
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Credential |
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Telephone | 850-769-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 60080969
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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