# CRESTVIEW HOSPITAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CRESTVIEW HOSPITAL CORPORATION
- **Other names:** Gateway Medical Clinic - Defuniak Springs
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770550964
- **Legal business name:** CRESTVIEW HOSPITAL CORPORATION
- **Authorized official:** PAULA LALOR (SR. DIRECTOR)
- **Authorized official phone:** (629) 215-3953

## Contact information

- **Practice address:** 1045 US HIGHWAY 331 S STE D, DEFUNIAK SPRINGS, FL 32435-3379
- **Practice address phone:** (850) 892-3366
- **Mailing address:** PO BOX 198002, ATLANTA, GA 30384-8002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | HCC3826 | FL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/07/2006
- **Last updated:** 03/21/2022