Provider Demographics
NPI:1033105820
Name:WASHINGTON REHABILITATION AND NURSING CENTER
Entity Type:Organization
Organization Name:WASHINGTON REHABILITATION AND NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMININSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-638-4654
Mailing Address - Street 1:879 USERY RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-9303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:850-638-0918
Practice Address - Street 1:879 USERY RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-9303
Practice Address - Country:US
Practice Address - Phone:850-638-4654
Practice Address - Fax:850-638-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1065096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105727Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER