Healthcare Provider Details

I. General information

NPI: 1619414752
Provider Name (Legal Business Name): HUGO1CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 E BUSINESS 98
PANAMA CITY FL
32401-4702
US

IV. Provider business mailing address

2515 E BUSINESS 98
PANAMA CITY FL
32401-4702
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-3624
  • Fax:
Mailing address:
  • Phone: 850-784-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SHERLENE MCCLARY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-784-3624