MEDICARE: CENTRE POINTE HRC 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	1081-96A	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053480061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRE POINTE HRC LLC

Provider Business Mailing Address
First Line	:	2255 CENTERVILLE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4315
Country	:	US
Telephone Number	:	850-386-4054
Fax Number	:	321-725-6168

Provider Business Practice Location Address
First Line	:	2255 CENTERVILLE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4315
Country	:	US
Telephone Number	:	850-386-4054
Fax Number	:	850-422-3206

Authorized Official
Title or Position	:	PRESIDENT AND COO
Name	:	JEFF CLEVELAND
Credential	:
Telephone Number	:	321-725-6131

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	01/15/2025

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