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NPI Code Detail

MEDICARE: GINGER DRIVE HEALTH CARE ASSOCIATES LLC

MEDICARE: GINGER DRIVE HEALTH CARE ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilitySNF12210961FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265487037
Entity Type Code : Organization
Provider Name (Legal Business Name) : GINGER DRIVE HEALTH CARE ASSOCIATES LLC
Provider Business Mailing Address
First Line : 3101 GINGER DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4437
Country : US
Telephone Number : 770-730-1103
Fax Number : 770-234-5498
Provider Business Practice Location Address
First Line : 3101 GINGER DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4437
Country : US
Telephone Number : 850-877-2177
Fax Number : 850-942-1202
Authorized Official
Title or Position : MANAGER
Name : CHARMION L. HOLMES
Credential :
Telephone Number : 850-877-2177
Provider Enumeration Date : 05/23/2006
Last Update Date : 11/27/2013

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1598036576 — LAURA LASSETER
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