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General NPI Number Information
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NPI Number | 1699189837
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Entity Type | Organization
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Legal Business Name | EMERALD COAST ADULT DAY CARE CENTER LLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 983 AIRPORT RD
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City | DESTIN
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State | FL
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Zip | 32541-2835
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Country | US
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Telephone | 850-460-2929
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Fax | 850-460-2952
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Provider Business Mailing Address
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Address Line | 983 AIRPORT RD
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City | DESTIN
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State | FL
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Zip | 32541-2835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. DONALD GROSSKOPF
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Credential |
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Telephone | 850-417-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 9277
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License Number State | FL
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