Organization
REHABILITATION CENTER AT PARK PLACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY SHAYNE BENCH (CFO)
(941) 758-4745
Entity
Organization
Contact information
Practice address
1717 W AVERY ST, PENSACOLA, FL 32501-1811
(850) 434-2355
Mailing address
5265 OFFICE PARK BLVD, SUITE 101, BRADENTON, FL 34203-3441
(941) 758-4745
(888) 391-2373
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104875-00
—
FL
Enumeration date
01/09/2014
Last updated
05/13/2014
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