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General NPI Number Information
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NPI Number | 1609142496
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Entity Type | Organization
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Legal Business Name | CENTER FOR INDEPENDENT LIVING OF NORTH FLORIDA, INC.
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 1823 BUFORD CT
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4465
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Country | US
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Telephone | 850-575-9621
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Fax | 850-575-5740
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Provider Business Mailing Address
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Address Line | 1823 BUFORD CT
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4465
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Country | US
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Telephone | 850-575-9621
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Fax | 850-575-5740
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JUDITH BARRETT
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Credential |
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Telephone | 850-575-9621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 753011
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License Number State | FL
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