Organization
500 SOUTH HOSPITAL DRIVE OPERATIONS LLC
Active
Other names
Shoal Creek Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH USSERY JR. (VP)
(407) 571-1550
Entity
Organization
Contact information
Practice address
500 HOSPITAL DR, CRESTVIEW, FL 32539-7355
(850) 689-3146
(850) 689-2286
Mailing address
500 HOSPITAL DR, CRESTVIEW, FL 32539-7355
(850) 689-3146
(850) 689-2286
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF130471012
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005985200
—
FL
Enumeration date
12/22/2011
Last updated
11/27/2023
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