Provider Demographics
NPI:1376613463
Name:DISC VILLAGE, INC.
Entity Type:Organization
Organization Name:DISC VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-766-1251
Mailing Address - Street 1:3333 W PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-2888
Mailing Address - Country:US
Mailing Address - Phone:850-575-4388
Mailing Address - Fax:850-576-3317
Practice Address - Street 1:150 10TH ST
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2103
Practice Address - Country:US
Practice Address - Phone:850-575-4388
Practice Address - Fax:850-576-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060600610Medicaid