Organization
CRESTVIEW REHABILITATION CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. R. MARK CRONQUIST (MANAGER)
(404) 574-2100
Entity
Organization
Contact information
Practice address
1849 E FIRST AVE, CRESTVIEW, FL 32539-3109
(850) 682-5322
(850) 682-5489
Mailing address
5887 GLENRIDGE DR NE, SUITE 150, ATLANTA, GA 30328-5574
(404) 574-2100
(404) 574-2105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1110096
FL
314000000X
Skilled Nursing Facility
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004488600
—
FL
Enumeration date
10/26/2011
Last updated
09/29/2014
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