Healthcare Provider Details

I. General information

NPI: 1548252810
Provider Name (Legal Business Name): PENSACOLA HEALTH TRUST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 WALNUT ST
WAYNESBORO MS
39367-2232
US

IV. Provider business mailing address

2 N PALAFOX ST
PENSACOLA FL
32502-5631
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-9025
  • Fax: 601-735-2865
Mailing address:
  • Phone: 850-430-0000
  • Fax: 850-436-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number162
License Number StateMS

VIII. Authorized Official

Name: SCOTT BELL
Title or Position: CEO PRESIDENT
Credential:
Phone: 850-430-0000