MEDICARE: DESOTO HEALTH & REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF11270961	FL

General Provider Information

NPI Number	:	1043266497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOTO HEALTH & REHAB LLC

Provider Business Mailing Address
First Line	:	1002 N BREVARD AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-8833
Country	:	US
Telephone Number	:	863-494-5766
Fax Number	:	863-494-9470

Provider Business Practice Location Address
First Line	:	1002 N BREVARD AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-8833
Country	:	US
Telephone Number	:	863-494-5766
Fax Number	:	863-494-9470

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. PHILIP JAMES CASTLEBERG
Credential	:	NHA
Telephone Number	:	863-494-5766

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/16/2008

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Directions to “DESOTO HEALTH & REHAB LLC ” Practice Location

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