Organization
CECROPIA S BALLARD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECROPIA BALLARD LCWS (EXECUTIVE DIRECTOR)
(850) 577-0208
Entity
Organization
Contact information
Practice address
1891 MYRICK RD, TALLAHASSEE, FL 32303-4335
(850) 766-8286
Mailing address
1891 MYRICK RD, TALLAHASSEE, FL 32303-4335
(850) 766-8286
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
SW7996
FL
310400000X
Assisted Living Facility
SW7996
FL
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
SW7996
FL
Other
Enumeration date
08/10/2012
Last updated
08/10/2012
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