MEDICARE: DISC VILLAGE, INC.

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
1	324500000X	Substance Abuse Rehabilitation Facility		FL

Other Identifiers

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

General Provider Information

NPI Number	:	1487619391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISC VILLAGE, INC.

Provider Business Mailing Address
First Line	:	3333 W PENSACOLA ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-2888
Country	:	US
Telephone Number	:	850-575-4388
Fax Number	:	850-576-3317

Provider Business Practice Location Address
First Line	:	3333 W PENSACOLA ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-2888
Country	:	US
Telephone Number	:	850-575-4388
Fax Number	:	850-576-3317

Authorized Official
Title or Position	:	QA DIRECTOR
Name	:	MELISSA SKIPTON
Credential	:
Telephone Number	:	850-766-1251

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	02/14/2022

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Directions to “DISC VILLAGE, INC. ” Practice Location

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