Healthcare Provider Details

I. General information

NPI: 1952356313
Provider Name (Legal Business Name): CORAL BAY HEALTH CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S HAVERHILL RD
WEST PALM BEACH FL
33415-8118
US

IV. Provider business mailing address

2939 S HAVERHILL RD
WEST PALM BEACH FL
33415-8118
US

V. Phone/Fax

Practice location:
  • Phone: 561-641-3130
  • Fax: 561-641-3167
Mailing address:
  • Phone: 561-641-3130
  • Fax: 561-641-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF10840961
License Number StateFL

VIII. Authorized Official

Name: STEVEN R. MELLION
Title or Position: MANAGER
Credential:
Phone: 561-641-3130