Provider Demographics
NPI:1265487037
Name:GINGER DRIVE HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:GINGER DRIVE HEALTH CARE ASSOCIATES LLC
Other - Org Name:HERITAGE HEALTHCARE CENTER AT TALLAHASSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARMION
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-877-2177
Mailing Address - Street 1:3101 GINGER DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4437
Mailing Address - Country:US
Mailing Address - Phone:770-730-1103
Mailing Address - Fax:770-234-5498
Practice Address - Street 1:3101 GINGER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4437
Practice Address - Country:US
Practice Address - Phone:850-877-2177
Practice Address - Fax:850-942-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12210961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025229800Medicaid
FL025229800Medicaid