Healthcare Provider Details

I. General information

NPI: 1184237851
Provider Name (Legal Business Name): PANAMA CITY FL OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 JENKS AVE
PANAMA CITY FL
32405-4530
US

IV. Provider business mailing address

440 SYLVAN AVE STE 240
ENGLEWOOD CLIFFS NJ
07632-2700
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0446
  • Fax:
Mailing address:
  • Phone: 201-928-7808
  • 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: BATYA GORELICK
Title or Position: VP OF ADMINISTRATIVE SERVICES
Credential:
Phone: 850-763-0446