Organization
PHC-CRESTVIEW INC
Active
Parent organization
PHC-CRESTVIEW INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHC-CRESTVIEW INC
Authorized official
MRS. CATHERINE A ATES R.N. (PRESIDENT, CHIEF OPERATING OFFICER)
(850) 682-5322
Entity
Organization
Contact information
Practice address
1849 E FIRST AVE, CRESTVIEW, FL 32539-3109
(850) 682-5322
(850) 682-5489
Mailing address
909 GARDEN GATE CIR, PENSACOLA, FL 32504-8629
(850) 479-1012
(850) 479-1013
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1110096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025110100
—
FL
Enumeration date
10/18/2005
Last updated
11/12/2009
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