Healthcare Provider Details

I. General information

NPI: 1578544649
Provider Name (Legal Business Name): HEALTHMARK OF WALTON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 US HIGHWAY 331 S
DEFUNIAK SPRINGS FL
32435-6307
US

IV. Provider business mailing address

4413 US HIGHWAY 331 S
DEFUNIAK SPRINGS FL
32435-6307
US

V. Phone/Fax

Practice location:
  • Phone: 850-951-4500
  • Fax:
Mailing address:
  • Phone: 850-951-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number212810961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4234
License Number StateFL

VIII. Authorized Official

Name: MS. LISA SHIRLEY HOLLEY
Title or Position: COO
Credential: MS
Phone: 850-951-4508