MEDICARE: CATHERINE'S HOUSE, 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	310400000X	Assisted Living Facility	AL11966958	FL

General Provider Information

NPI Number	:	1538367388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHERINE'S HOUSE, INC.

Provider Business Mailing Address
First Line	:	6595 DAMON CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-8706
Country	:	US
Telephone Number	:	850-241-4466
Fax Number	:	850-421-8587

Provider Business Practice Location Address
First Line	:	6595 DAMON CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-8706
Country	:	US
Telephone Number	:	850-241-4466
Fax Number	:	850-421-8587

Authorized Official
Title or Position	:	OWNER ADMINISTRATOR
Name	:	MS. TEMEKA BRUCE
Credential	:
Telephone Number	:	850-241-4466

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	08/22/2020

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