Provider Demographics
NPI:1770911786
Name:APALACHEE CENTER, INC
Entity type:Organization
Organization Name:APALACHEE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-997-3958
Mailing Address - Street 1:1996 S JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-5100
Mailing Address - Country:US
Mailing Address - Phone:850-997-3958
Mailing Address - Fax:850-997-0983
Practice Address - Street 1:1996 S JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-5100
Practice Address - Country:US
Practice Address - Phone:850-997-3958
Practice Address - Fax:850-997-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization