MEDICARE: PANAMA CITY FL OPCO 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

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	:	1184237851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANAMA CITY FL OPCO LLC

Provider Business Mailing Address
First Line	:	440 SYLVAN AVE STE 240
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2700
Country	:	US
Telephone Number	:	201-928-7808
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4530
Country	:	US
Telephone Number	:	850-763-0446
Fax Number	:

Authorized Official
Title or Position	:	VP OF ADMINISTRATIVE SERVICES
Name	:	BATYA GORELICK
Credential	:
Telephone Number	:	850-763-0446

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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Directions to “PANAMA CITY FL OPCO LLC ” Practice Location

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