TALLAHASSEE DEVELOPMENTAL CENTER (NPI# 1609875160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609875160 |
| Entity Type | Organization |
| Organization Name | TALLAHASSEE DEVELOPMENTAL CENTER |
| Practice Address |
455 Appleyard Dr Tallahassee FL 32304-2808 |
| Practice Telephone | 8505750619 |
| Practice Fax Number | 8505765773 |
| Mailing Telephone | 8505750619 |
| Mailing Fax Number | 8505765773 |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. FRED JIMINEZ (PROGRAM SERVICES DIRECTOR) |
| Authorized Official Telephone | 8505750619 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310500000X | Intermediate Care Facility, Mental Illness | 4096096 | FL | Nursing & Custodial Care Facilities |
| Street Address |
455 APPLEYARD DR |
| City | TALLAHASSEE |
| State | FL |
| Zip Code | 32304-2808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827288 | Florida Mentor II LLC | Intermediate Care Facility, Mentally Retarded | 455 Appleyard Dr, Tallahassee, FL 32304-2808 | 2020-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982214946 | Jamel V Chandler | Adult Companion | 2665 Mission Road., Tallahassee, FL 32304 | 2020-08-05 |
| 1578198248 | Thomson Ivins | Counselor | 175 Geddie Rd, Tallahassee, FL 32304 | 2020-03-03 |
| 1508210022 | Angela Nechele Hall | Physical Therapist | 1329 Abraham Street, Tallahassee, FL 32304 | 2016-04-21 |
| 1780064329 | Bennie Thompkins | Dentist | 535 Apple Yard Dr, Tallahassee, FL 32304 | 2015-06-08 |
| 1104241314 | Osita Abanah | Pharmacist | 1819 West Tennessee St, Tallahassee, FL 32304 | 2014-02-25 |
| 1437584265 | Kristan Aliesha Morgan | Nurse Practitioner | 501 Capital Circle Ne, Tallahassee, FL 32304 | 2013-09-11 |
| 1649550047 | Bond Community Health Center, Inc. | Internal Medicine | 1704 Joe Lewis Street, Tallahassee, FL 32304 | 2011-08-17 |
| 1639309842 | Bond Community Health Center | Internal Medicine | 2729-8 Municipal Way, Kay Freeman Health Center, Tallahassee, FL 32304 | 2009-07-22 |
| 1104016401 | Elder Care Services, Inc. | Homemaker | 2518 W Tennessee St, Tallahassee, FL 32304 | 2007-08-01 |
| 1760548234 | Patricia Janice Mitchell | Adult Companion | 4177 Pleasant Drive, Tallahassee, FL 32304 | 2006-12-29 |
| Find all providers in zip 32304 | ||||
| Taxonomy Code | 310500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mental Illness |
| A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902420854 | Sunrise Community, Inc. | Intermediate Care Facility, Mental Illness | 817 W Wheeler Rd, Brandon, FL 33510-2140 | 2020-06-05 |
| 1174050371 | Andre Morris | Intermediate Care Facility, Mental Illness | 338 Daniels Pointe Dr, Winter Garden, FL 34787-4347 | 2017-05-18 |
| 1184920605 | Carine Robert | Intermediate Care Facility, Mental Illness | 11999 Nw 13th St, Pembroke Pines, FL 33026-3878 | 2011-01-31 |
| 1710162466 | Natalie and Erik Tiltins | Intermediate Care Facility, Mental Illness | 17919 Hwy. 231, Fountain, FL 32438 | 2007-12-31 |
| 1417137225 | Natalie and Erik Tiltins | Intermediate Care Facility, Mental Illness | 17919 Highway 231, Fountain, FL 32438-0500 | 2007-11-08 |
| 1942489265 | Sunshine Acres Assisted Living Facility, Inc. | Intermediate Care Facility, Mental Illness | 2563 River Rd, Caryville, FL 32427-2013 | 2007-11-02 |
| 1699802207 | Priority Life Services, Corp | Intermediate Care Facility, Mental Illness | 707 S 19th Ave Apt 6, Hollywood, FL 33020-5400 | 2007-02-28 |
| 1578600094 | Hll of Miami Corp | Intermediate Care Facility, Mental Illness | 9441 Sw 27th Dr, Miami, FL 33165-3103 | 2007-01-31 |
| 1366598484 | National Mentor Healthcare Network | Intermediate Care Facility, Mental Illness | 5808 Kinkaid Rd, Jacksonville, FL 32244-1034 | 2007-01-25 |
| 1568461671 | Panama City Developmental Center | Intermediate Care Facility, Mental Illness | 1407 Lincoln Dr, Panama City, FL 32401-2870 | 2005-07-20 |
| Find all providers with the same taxonomy | ||||
| City | TALLAHASSEE |
| Zip Code | 32304 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.