Healthcare Provider Details

I. General information

NPI: 1346976842
Provider Name (Legal Business Name): GRACEVILLE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 SANDERS AVE
GRACEVILLE FL
32440-1854
US

IV. Provider business mailing address

1083 SANDERS AVE
GRACEVILLE FL
32440-1854
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-4447
  • Fax:
Mailing address:
  • Phone: 850-263-4447
  • 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: MAYER FISCHL
Title or Position: CFO
Credential:
Phone: 718-757-6399