MEDICARE: DESTIN HEALTH CARE ASSOCIATES 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	SNF16210961	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	:	1952357923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTIN HEALTH CARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	195 MATTIE M KELLY BLVD
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2811
Country	:	US
Telephone Number	:	850-654-4588
Fax Number	:	850-654-3944

Provider Business Practice Location Address
First Line	:	195 MATTIE M KELLY BLVD
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2811
Country	:	US
Telephone Number	:	850-654-4588
Fax Number	:	850-654-3944

Authorized Official
Title or Position	:	MANAGER
Name	:	AMANDA M. ADAMS
Credential	:
Telephone Number	:	850-654-4588

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	11/04/2012

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