Provider Demographics
NPI:1033360862
Name:BLOUNTSTOWN HEALTH & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:BLOUNTSTOWN HEALTH & REHABILITATION CENTER, LLC
Other - Org Name:BLOUNTSTOWN HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-324-8898
Mailing Address - Street 1:PO BOX 3343
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-3343
Mailing Address - Country:US
Mailing Address - Phone:828-324-8898
Mailing Address - Fax:828-322-9598
Practice Address - Street 1:16690 SW CHIPOLA RD
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1953
Practice Address - Country:US
Practice Address - Phone:850-674-4311
Practice Address - Fax:850-674-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1652096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105924Medicare Oscar/Certification