NPIMap

Organization Active NPI

Tallahassee Developmental Center

  • Mental Illness Intermediate Care Facility
  • Tallahassee, FL
National Provider Identifier
1609875160
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
4096096 Issued in FL
Legal business name
TALLAHASSEE DEVELOPMENTAL CENTER
Practice address
455 Appleyard Dr
Tallahassee, FL 32304-2808
Phone
(850) 575-0619
Fax
(850) 576-5773
NPI assigned
Jul 18, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Fred Jiminez
Title
Program Services Director
Phone
(850) 575-0619

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 4096096 FL Primary

Addresses

Primary practice location

455 Appleyard Dr
Tallahassee, FL 32304-2808

Mailing address

455 Appleyard Dr
Tallahassee, FL 32304-2808
Phone (850) 575-0619

National Provider Directory

National Provider Directory
Tax ID family
Fort Walton Beach Developmental Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609875160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 APPLEYARD DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323042808",
            "telephone_number": "850-575-0619",
            "fax_number": "850-576-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 APPLEYARD DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323042808",
            "telephone_number": "850-575-0619",
            "fax_number": "850-576-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JIMINEZ",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "PROGRAM SERVICES DIRECTOR",
        "authorized_official_telephone_number": "850-575-0619",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "FL",
            "license": "4096096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.