Provider Demographics
NPI:1942661020
Name:MELISSA'S PLACE INC.
Entity Type:Organization
Organization Name:MELISSA'S PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-399-6862
Mailing Address - Street 1:711 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-3502
Mailing Address - Country:US
Mailing Address - Phone:352-399-6862
Mailing Address - Fax:352-399-6863
Practice Address - Street 1:711 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3502
Practice Address - Country:US
Practice Address - Phone:352-399-6862
Practice Address - Fax:352-399-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9263261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010649900Medicaid