MEDICARE: APPETITE FOR LIFE

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	332U00000X	Home Delivered Meals	17481460283	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851715734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPETITE FOR LIFE

Provider Business Mailing Address
First Line	:	402 W CERVANTES ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-3032
Country	:	US
Telephone Number	:	850-470-9111
Fax Number	:	850-470-0201

Provider Business Practice Location Address
First Line	:	402 W CERVANTES ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-3032
Country	:	US
Telephone Number	:	850-470-9111
Fax Number	:	850-470-0201

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CELESTE SOUTHARD
Credential	:
Telephone Number	:	850-470-9111

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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Directions to “APPETITE FOR LIFE ” Practice Location

Language	Start Address	Practice Location

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