Healthcare Provider Details

I. General information

NPI: 1114065943
Provider Name (Legal Business Name): RESIDENTIAL CRF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 STATE AVE
PANAMA CITY FL
32405-4359
US

IV. Provider business mailing address

700 W 23RD ST SUITE 52
PANAMA CITY FL
32405-3936
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-0605
  • Fax: 850-785-8061
Mailing address:
  • Phone: 850-785-0605
  • Fax: 850-785-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED SCHILLING
Title or Position: CFO
Credential:
Phone: 765-827-6996