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NPI Code Detail

MEDICARE: COQUINA CENTER, LLC

MEDICARE: COQUINA CENTER, 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
1314000000XSkilled Nursing FacilitySNF13470961FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C105589OTHERFLUNITED AMERICAN
20004438178OTHERFLAETNA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
471-00466OTHERFLUNITED HEALTH CARE
5K4ZOTHERFLBLUE CROSS BLUE SHIELD
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760470785
Entity Type Code : Organization
Provider Name (Legal Business Name) : COQUINA CENTER, LLC
Provider Business Mailing Address
First Line : 170 N CENTER ST
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-5186
Country : US
Telephone Number : 386-672-7113
Fax Number : 386-672-7128
Provider Business Practice Location Address
First Line : 170 N CENTER ST
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-5186
Country : US
Telephone Number : 386-672-7113
Fax Number : 386-672-7128
Authorized Official
Title or Position : VP FINANCE
Name : MRS. JENNIFER ALISE ZIOLKOWSKI
Credential : MBA
Telephone Number : 813-558-6629
Provider Enumeration Date : 10/13/2005
Last Update Date : 06/12/2024

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