Healthcare Provider Details

I. General information

NPI: 1043266497
Provider Name (Legal Business Name): DESOTO HEALTH & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N BREVARD AVE
ARCADIA FL
34266-8833
US

IV. Provider business mailing address

1002 N BREVARD AVE
ARCADIA FL
34266-8833
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-5766
  • Fax: 863-494-9470
Mailing address:
  • Phone: 863-494-5766
  • Fax: 863-494-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF11270961
License Number StateFL

VIII. Authorized Official

Name: MR. PHILIP JAMES CASTLEBERG
Title or Position: PARTNER
Credential: NHA
Phone: 863-494-5766