Healthcare Provider Details

I. General information

NPI: 1134724487
Provider Name (Legal Business Name): CENTER FOR AGING AND REHABILITATION OF GULF COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 9TH ST
PORT ST JOE FL
32456-1924
US

IV. Provider business mailing address

100 SE 2ND ST STE 2000
MIAMI FL
33131-2101
US

V. Phone/Fax

Practice location:
  • Phone: 850-229-8244
  • Fax: 850-229-1042
Mailing address:
  • Phone: 954-367-4597
  • Fax: 954-367-4564

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: ROBERT ALAN BROCK
Title or Position: PRESIDENT
Credential:
Phone: 954-367-4597