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NPI Code Detail

MEDICARE: EMERALD SHORES HEALTH CARE ASSOCIATES LLC

MEDICARE: EMERALD SHORES HEALTH CARE ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilitySNF1292096FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023093804
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMERALD SHORES HEALTH CARE ASSOCIATES LLC
Provider Business Mailing Address
First Line : 626 N TYNDALL PKWY
Second Line :
City : CALLAWAY
State : FL
Zip : 32404-6132
Country : US
Telephone Number : 850-871-6363
Fax Number : 850-871-6367
Provider Business Practice Location Address
First Line : 626 N TYNDALL PKWY
Second Line :
City : CALLAWAY
State : FL
Zip : 32404-6132
Country : US
Telephone Number : 850-871-6363
Fax Number : 850-871-6367
Authorized Official
Title or Position : MANAGER
Name : JEFFREY C. MARK
Credential :
Telephone Number : 850-871-6363
Provider Enumeration Date : 12/14/2005
Last Update Date : 11/19/2013

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