Organization
FORT WALTON 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
1 L B J SR DR, FORT WALTON BEACH, FL 32547-1163
(850) 863-2066
(850) 863-9006
Mailing address
5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA 30328-5574
(404) 574-2100
(404) 574-2105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF11610951
FL
314000000X
Skilled Nursing Facility
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004488800
—
FL
Enumeration date
10/26/2011
Last updated
09/29/2014
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