Provider Demographics
NPI:1003394693
Name:CPLACE BRISTOL SNF, LLC
Entity Type:Organization
Organization Name:CPLACE BRISTOL SNF, LLC
Other - Org Name:THE REHAB CENTER AT BRISTOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:337-349-5061
Mailing Address - Street 1:24641 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-5007
Mailing Address - Country:US
Mailing Address - Phone:337-349-5061
Mailing Address - Fax:
Practice Address - Street 1:109 VILLAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:727-239-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility