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General NPI Number Information
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NPI Number | 1891799623
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Entity Type | Organization
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Legal Business Name | EMERALD COAST REHABILITATION CENTER, LLC
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 114 3RD ST SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5401
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Country | US
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Telephone | 850-243-6134
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Fax | 850-243-9759
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Provider Business Mailing Address
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Address Line | 1665 PALM BEACH LAKES BLVD STE 400
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2108
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Country | US
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Telephone | 561-223-4300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOWARD JAFFE
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Credential |
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Telephone | 215-346-6454
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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 | SNF11410961
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License Number State | FL
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