Healthcare Provider Details

I. General information

NPI: 1679560577
Provider Name (Legal Business Name): WALTON COUNTY CONVALESCENT CENTER OPERATIONS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 850-892-2176
  • Fax: 850-892-0781
Mailing address:
  • Phone: 850-892-2176
  • Fax: 850-892-0781

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: DAWNE P DRIES
Title or Position: ADMINISTRATOR
Credential: NH
Phone: 850-892-2176