Healthcare Provider Details

I. General information

NPI: 1245286822
Provider Name (Legal Business Name): NINTH STREET HEALTH CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 9TH ST N
NAPLES FL
34102-8135
US

IV. Provider business mailing address

777 9TH ST N
NAPLES FL
34102-8135
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-8126
  • Fax: 239-261-8647
Mailing address:
  • Phone: 239-261-8126
  • Fax: 239-261-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1224096
License Number StateFL

VIII. Authorized Official

Name: CHRISSANDA D. WALKER
Title or Position: MANAGER
Credential:
Phone: 239-261-8126