Provider Demographics
NPI:1225274582
Name:REFLECTIONS CARE CLUB, INC
Entity Type:Organization
Organization Name:REFLECTIONS CARE CLUB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOLEY-SEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-498-6888
Mailing Address - Street 1:5711 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4402
Mailing Address - Country:US
Mailing Address - Phone:239-498-6888
Mailing Address - Fax:239-466-6209
Practice Address - Street 1:5711 INDEPENDENCE CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4402
Practice Address - Country:US
Practice Address - Phone:239-498-6888
Practice Address - Fax:239-466-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9094261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care