Healthcare Provider Details

I. General information

NPI: 1194770420
Provider Name (Legal Business Name): CORAL HEALTH CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-4600
  • Fax: 239-772-9842
Mailing address:
  • Phone: 239-772-4600
  • Fax: 239-772-9842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF11040961
License Number StateFL

VIII. Authorized Official

Name: KAROLE Y. HAMILTON
Title or Position: MANAGER
Credential:
Phone: 239-772-4600