Healthcare Provider Details

I. General information

NPI: 1831188952
Provider Name (Legal Business Name): COURTYARD MILLPOND OPERATIONS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FOREST GLEN TRL
MARIANNA FL
32446-0100
US

IV. Provider business mailing address

2600 FOREST GLEN TRL
MARIANNA FL
32446-0100
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-2000
  • Fax: 850-526-3000
Mailing address:
  • Phone: 850-526-2000
  • Fax: 850-526-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ANNETTE BARNES JANSENIUS
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-526-2000