Organization · NPI-2

500 South Hospital Drive Operations LLC

Skilled Nursing Facility · Crestview, FL

NPI number1689943458
StatusActive
Last updated in NPPESNov 27, 2023

Details

NPI
1689943458
Entity type
Organization (NPI-2)
Legal business name
500 South Hospital Drive Operations LLC
Organization subpart
No
Enumeration date
Dec 22, 2011
Certification date
May 18, 2020
Last updated
Nov 27, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing FacilitySNF130471012FLYes

Other names

  • Shoal Creek Rehabilitation Center (Doing Business As)

Practice location

500 Hospital Dr
Crestview, FL 32539-7355

Phone 850-689-3146 · Fax 850-689-2286

Mailing address

500 Hospital Dr
Crestview, FL 32539-7355

Phone 850-689-3146 · Fax 850-689-2286

Authorized official

Kenneth Ussery
Vp
4075711550

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