MEDICARE: THE CANOPY AT WALDEN WOODS

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

General Provider Information

NPI Number	:	1619735214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CANOPY AT WALDEN WOODS

Provider Business Mailing Address
First Line	:	2573 BARRINGTON CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-6805
Country	:	US
Telephone Number	:	850-712-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 WALDEN WOODS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-3610
Country	:	US
Telephone Number	:	850-712-5566
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	MARISA STRAIN
Credential	:	RN
Telephone Number	:	850-712-5566

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/25/2024

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Directions to “THE CANOPY AT WALDEN WOODS ” Practice Location

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