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General NPI Number Information
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NPI Number | 1770550964
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Entity Type | Organization
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Legal Business Name | CRESTVIEW HOSPITAL CORPORATION
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 1045 US HIGHWAY 331 S STE D
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-3379
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Country | US
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Telephone | 850-892-3366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198002
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City | ATLANTA
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State | GA
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Zip | 30384-8002
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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 | SR. DIRECTOR
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Name | PAULA LALOR
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Credential |
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Telephone | 629-215-3953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | HCC3826
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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