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General NPI Number Information
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NPI Number | 1396790622
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Entity Type | Organization
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Legal Business Name | NORTHPORT HEALTH SERVICES OF FLORIDA, LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 136 NE 12TH AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4553
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Country | US
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Telephone | 352-795-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 136 NE 12TH AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4553
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | PHILLIP CODY LONG
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Credential |
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Telephone | 204-391-3600
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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 | SNF1114096
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License Number State | FL
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