Organization
PENSACOLA HEALTH TRUST INC
Active
Other names
Lakeside Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT J BELL (CEO PRESIDENT)
(850) 430-0000
Entity
Organization
Contact information
Practice address
191 HIGHWAY 511, QUITMAN, MS 39355-8320
(601) 776-2141
(601) 776-5782
Mailing address
2 N PALAFOX ST, PENSACOLA, FL 32502-5631
(850) 430-0000
(850) 436-6766
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
290
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230104
—
MS
Enumeration date
08/22/2005
Last updated
08/22/2020
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