Provider Demographics
NPI:1043266497
Name:DESOTO HEALTH & REHAB LLC
Entity Type:Organization
Organization Name:DESOTO HEALTH & REHAB LLC
Other - Org Name:DESOTO HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CASTLEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:863-494-5766
Mailing Address - Street 1:1002 N BREVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8833
Mailing Address - Country:US
Mailing Address - Phone:863-494-5766
Mailing Address - Fax:863-494-9470
Practice Address - Street 1:1002 N BREVARD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8833
Practice Address - Country:US
Practice Address - Phone:863-494-5766
Practice Address - Fax:863-494-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11270961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106070Medicare Oscar/Certification