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General NPI Number Information
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NPI Number | 1902108418
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Entity Type | Organization
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Legal Business Name | ELDERCARE SERVICES OF TALLAHASSEE
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 2507 OLD SAINT AUGUSTINE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32301-6209
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Country | US
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Telephone | 850-309-1982
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Fax | 850-597-8305
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Provider Business Mailing Address
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Address Line | 2507 OLD SAINT AUGUSTINE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32301-6209
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Country | US
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Telephone | 850-309-1982
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Fax | 850-597-8305
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SCOTT BROOKINS
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Credential | OWNER
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Telephone | 850-309-1982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9149
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License Number State | FL
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