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Organization

PHC-BLOUNTSTOWN INC

Active
Parent organization
PHC-BLOUNTSTOWN INC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PHC-BLOUNTSTOWN INC
Authorized official
MRS. CATHERINE A ATES R.N. (PRESIDENT, CHIEF OPERATING OFFICER)
(850) 682-5322
Entity
Organization

Contact information

Practice address
17884 NE CROZIER ST, BLOUNTSTOWN, FL 32424-1050
(850) 674-5464
(850) 674-9384
Mailing address
909 GARDEN GATE CIR, PENSACOLA, FL 32504-8629
(850) 682-5322
(850) 689-2510

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF12870961
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
025109700
FL
Enumeration date
11/01/2005
Last updated
06/17/2008
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