Healthcare Provider Details

I. General information

NPI: 1710795877
Provider Name (Legal Business Name): MARIANNA REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 5TH AVE
MARIANNA FL
32446-2176
US

IV. Provider business mailing address

4295 5TH AVE
MARIANNA FL
32446-2176
US

V. Phone/Fax

Practice location:
  • Phone: 850-482-8091
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. DONALD KEITH MELTON II
Title or Position: CFO
Credential:
Phone: 407-215-8610