MEDICARE: RESIDENTIAL CRF, INC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1114065943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL CRF, INC

Provider Business Mailing Address
First Line	:	700 W 23RD ST
Second Line	:	SUITE 52
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3936
Country	:	US
Telephone Number	:	850-785-0605
Fax Number	:	850-785-8061

Provider Business Practice Location Address
First Line	:	2603 STATE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4359
Country	:	US
Telephone Number	:	850-785-0605
Fax Number	:	850-785-8061

Authorized Official
Title or Position	:	CFO
Name	:	MR. FRED SCHILLING
Credential	:
Telephone Number	:	765-827-6996

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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