Organization
NORTHPORT HEALTH SERVICES OF FLORIDA, LLC
Active
Other names
Crystal River Health & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP CODY LONG (CFO)
(204) 391-3600
Entity
Organization
Contact information
Practice address
136 NE 12TH AVE, CRYSTAL RIVER, FL 34429-4553
(352) 795-5044
Mailing address
136 NE 12TH AVE, CRYSTAL RIVER, FL 34429-4553
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1114096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021726300
—
FL
Enumeration date
05/24/2006
Last updated
10/27/2020
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