Organization · NPI-2

Phc-Crestview INC

Skilled Nursing Facility · Crestview, FL

NPI number1891784344
StatusActive
Last updated in NPPESNov 12, 2009

Details

NPI
1891784344
Entity type
Organization (NPI-2)
Legal business name
Phc-Crestview INC
Organization subpart
Yes
Enumeration date
Oct 18, 2005
Last updated
Nov 12, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing FacilitySNF1110096FLYes

Practice location

1849 E First Ave
Crestview, FL 32539-3109

Phone 850-682-5322 · Fax 850-682-5489

Mailing address

909 Garden Gate Cir
Pensacola, FL 32504-8629

Phone 850-479-1012 · Fax 850-479-1013

Authorized official

Catherine A Ates
President, Chief Operating Officer
8506825322

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