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General NPI Number Information
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NPI Number | 1669729406
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Entity Type | Organization
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Legal Business Name | COLUMBIA CREST CONSTRUCTION, LLC
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Dates
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Enumeration Date | 08/11/2012
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Last Update Date | 08/11/2012
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Provider Practice Location Address
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Address Line | 3909 RESERVE DR STE 2818
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City | TALLAHASSEE
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State | FL
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Zip | 32311-8200
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Country | US
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Telephone | 850-591-1350
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Fax | 850-807-2585
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Provider Business Mailing Address
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Address Line | 3909 RESERVE DR STE 2818
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City | TALLAHASSEE
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State | FL
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Zip | 32311-8200
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Country | US
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Telephone | 850-591-1350
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Fax | 850-807-2585
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Authorized Official
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Title or Position | SOLE MBR
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Name | MR. ERIK E BROWN
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Credential |
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Telephone | 850-591-1350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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