MEDICARE: BOWLING GREEN INN OF PENSACOLA, 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	323P00000X	Psychiatric Residential Treatment Facility
2	324500000X	Substance Abuse Rehabilitation Facility	0157AD552301	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0157AD552301	OTHER	FL	STATE OF FLORIDA

General Provider Information

NPI Number	:	1881784312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWLING GREEN INN OF PENSACOLA, LLC

Provider Business Mailing Address
First Line	:	6100 TOWER CIR STE 1000
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-1509
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2068 HEALTH CARE AVE
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-2901
Country	:	US
Telephone Number	:	850-939-1200
Fax Number	:	850-939-1257

Authorized Official
Title or Position	:	VP & SECRETARY
Name	:	BRIAN P FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/28/2023

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