Healthcare Provider Details

I. General information

NPI: 1063404754
Provider Name (Legal Business Name): CORDOVA REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 E. HIGHWAY BUSINESS 98
PANAMA CITY FL
32401-3632
US

IV. Provider business mailing address

2 N PALAFOX ST
PENSACOLA FL
32502-5631
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-1438
  • Fax: 850-763-9711
Mailing address:
  • Phone: 850-430-0000
  • Fax: 850-436-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF11740962
License Number StateFL

VIII. Authorized Official

Name: SCOTT J BELL
Title or Position: CEO PRESIDENT
Credential:
Phone: 850-430-0000