MEDICARE: CATALINA 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
1	314000000X	Skilled Nursing Facility	SNF1191096	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1720033616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATALINA HEALTH CARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	820 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4594
Country	:	US
Telephone Number	:	386-274-4575
Fax Number	:	386-274-5020

Provider Business Practice Location Address
First Line	:	820 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4594
Country	:	US
Telephone Number	:	386-274-4575
Fax Number	:	386-274-5020

Authorized Official
Title or Position	:	MANAGER
Name	:	BREWIER W. WELCH
Credential	:
Telephone Number	:	386-274-4575

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/25/2010

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