Healthcare Provider Details

I. General information

NPI: 1982605085
Provider Name (Legal Business Name): OKEECHOBEE COUNCIL ON AGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S BARFIELD HWY
PAHOKEE FL
33476-1834
US

IV. Provider business mailing address

1311 SW 16TH ST
GAINESVILLE FL
32608-1128
US

V. Phone/Fax

Practice location:
  • Phone: 561-924-5561
  • Fax: 561-924-9466
Mailing address:
  • Phone: 352-376-8821
  • Fax: 352-376-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1172096
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier020320300
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name: MR. EDWARD W HURT
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 352-376-8821