Provider Demographics
NPI:1083762504
Name:BIG BEND COMMUNTIY BASED CARE
Entity Type:Organization
Organization Name:BIG BEND COMMUNTIY BASED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-410-1020
Mailing Address - Street 1:525 N MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1054
Mailing Address - Country:US
Mailing Address - Phone:850-410-1020
Mailing Address - Fax:850-410-1076
Practice Address - Street 1:525 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1054
Practice Address - Country:US
Practice Address - Phone:850-410-1020
Practice Address - Fax:850-410-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL02B010401P251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare