Provider Demographics
NPI:1356632145
Name:REFLECTIONS OF JUPITER LLC
Entity Type:Organization
Organization Name:REFLECTIONS OF JUPITER LLC
Other - Org Name:REFLECTIONS AT QUIET WATERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRIPPALDI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:561-721-4699
Mailing Address - Street 1:306 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3282
Mailing Address - Country:US
Mailing Address - Phone:561-721-4699
Mailing Address - Fax:561-844-0358
Practice Address - Street 1:306 SW10 TH STREET
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430
Practice Address - Country:US
Practice Address - Phone:561-721-4699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9160261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003102100Medicaid