Healthcare Provider Details

I. General information

NPI: 1295770477
Provider Name (Legal Business Name): HEALTH CENTER OF BLUE WATER BAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WHITE POINT RD
NICEVILLE FL
32578-4249
US

IV. Provider business mailing address

1500 WHITE POINT RD
NICEVILLE FL
32578-4249
US

V. Phone/Fax

Practice location:
  • Phone: 850-897-5592
  • Fax:
Mailing address:
  • Phone: 850-897-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF13080951
License Number StateFL

VIII. Authorized Official

Name: STEVE STRAWN
Title or Position: DIRECTOR
Credential:
Phone: 615-217-2324