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General NPI Number Information
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NPI Number | 1891784344
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Entity Type | Organization
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Legal Business Name | PHC-CRESTVIEW INC
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 1849 E FIRST AVE
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City | CRESTVIEW
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State | FL
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Zip | 32539-3109
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Country | US
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Telephone | 850-682-5322
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Fax | 850-682-5489
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Provider Business Mailing Address
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Address Line | 909 GARDEN GATE CIR
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City | PENSACOLA
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State | FL
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Zip | 32504-8629
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Country | US
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Telephone | 850-479-1012
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Fax | 850-479-1013
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Authorized Official
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Title or Position | PRESIDENT, CHIEF OPERATING OFFICER
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Name | MRS. CATHERINE A ATES
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Credential | R.N.
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Telephone | 850-682-5322
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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 | SNF1110096
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License Number State | FL
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