Organization
PHC-FT WALTON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM AROL HUDSON MBA (ADMINISTRATOR)
(850) 863-2066
Entity
Organization
Contact information
Practice address
1 L B J SR DR, FT WALTON BEACH, FL 32547-1163
(850) 863-2066
(850) 863-9006
Mailing address
909 GARDENGATE CIR, PENSACOLA, FL 32504
(850) 479-1012
(850) 479-1013
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
FL14605
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022923700
—
FL
Enumeration date
10/31/2005
Last updated
11/12/2009
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