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General NPI Number Information
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NPI Number | 1104717461
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Entity Type | Organization
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Legal Business Name | DEFUNIAK SPRINGS HCC LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 785 S 2ND ST
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-4903
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Country | US
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Telephone | 850-892-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 548 CEDARWOOD DR
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City | CEDARHURST
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State | NY
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Zip | 11516-1010
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Country | US
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Telephone | 850-892-2176
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Fax |
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Authorized Official
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Title or Position | EVP
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Name | CHAIM LEIBOWITZ
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Credential |
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Telephone | 850-892-2176
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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 |
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License Number State |
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