Healthcare Provider Details

I. General information

NPI: 1104717461
Provider Name (Legal Business Name): DEFUNIAK SPRINGS HCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 S 2ND ST
DEFUNIAK SPRINGS FL
32435-4903
US

IV. Provider business mailing address

548 CEDARWOOD DR
CEDARHURST NY
11516-1010
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-2176
  • Fax:
Mailing address:
  • Phone: 850-892-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAIM LEIBOWITZ
Title or Position: EVP
Credential:
Phone: 850-892-2176