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General NPI Number Information
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NPI Number | 1043266497
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Entity Type | Organization
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Legal Business Name | DESOTO HEALTH & REHAB LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 1002 N BREVARD AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8833
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Country | US
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Telephone | 863-494-5766
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Fax | 863-494-9470
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Provider Business Mailing Address
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Address Line | 1002 N BREVARD AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8833
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Country | US
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Telephone | 863-494-5766
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Fax | 863-494-9470
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Authorized Official
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Title or Position | PARTNER
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Name | MR. PHILIP JAMES CASTLEBERG
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Credential | NHA
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Telephone | 863-494-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF11270961
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License Number State | FL
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