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General NPI Number Information
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NPI Number | 1669258455
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Entity Type | Organization
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Legal Business Name | GENCARE KIDS PPEC PLUS LEARNING CENTER MELBOURNE, LLC
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 335 PINEDA CT
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City | MELBOURNE
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State | FL
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Zip | 32940-6504
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Country | US
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Telephone | 888-425-7732
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Fax | 407-440-2876
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Provider Business Mailing Address
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Address Line | 335 PINEDA CT
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City | MELBOURNE
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State | FL
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Zip | 32940-6504
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Country | US
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Telephone | 888-425-7732
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Fax | 407-440-2876
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. OLIVE GAYE
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Credential | MBA
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Telephone | 888-425-7732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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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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