MEDICARE: LILY-ROSE FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	225100000X	Physical Therapist
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251S00000X	Community/Behavioral Health Agency
5	261QA0600X	Adult Day Care Clinic/Center
6	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1093662413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILY-ROSE FOUNDATION

Provider Business Mailing Address
First Line	:	3482 HYDE PARK WAY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-8206
Country	:	US
Telephone Number	:	850-345-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	3482 HYDE PARK WAY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-8206
Country	:	US
Telephone Number	:	850-345-6666
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHARLOTTE GRANT
Credential	:	OT
Telephone Number	:	850-345-6666

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “LILY-ROSE FOUNDATION ” Practice Location

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