Provider Demographics
NPI:1750486163
Name:TALLAHASSEE MEMORIAL ADULT DAY CARE
Entity Type:Organization
Organization Name:TALLAHASSEE MEMORIAL ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-431-5371
Mailing Address - Street 1:2039 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4727
Mailing Address - Country:US
Mailing Address - Phone:850-531-0712
Mailing Address - Fax:850-531-9863
Practice Address - Street 1:2039 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4727
Practice Address - Country:US
Practice Address - Phone:850-531-0712
Practice Address - Fax:850-531-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8907385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFED TAX ID