Provider Demographics
NPI:1083220560
Name:TAMBOLINA ADULT DAY CARE
Entity type:Organization
Organization Name:TAMBOLINA ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:FUSTER
Authorized Official - Last Name:MOMORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-651-1310
Mailing Address - Street 1:1627 ROGERO RD STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4866
Mailing Address - Country:US
Mailing Address - Phone:904-553-1013
Mailing Address - Fax:904-240-0309
Practice Address - Street 1:1627 ROGERO RD STE C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4866
Practice Address - Country:US
Practice Address - Phone:904-553-1013
Practice Address - Fax:904-240-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care