Provider Demographics
NPI:1053480061
Name:CENTRE POINTE HRC LLC
Entity Type:Organization
Organization Name:CENTRE POINTE HRC LLC
Other - Org Name:CENTRE POINTE HEALTH AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-725-6131
Mailing Address - Street 1:175 E NASA BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1998
Mailing Address - Country:US
Mailing Address - Phone:321-725-6131
Mailing Address - Fax:321-725-6168
Practice Address - Street 1:2255 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4315
Practice Address - Country:US
Practice Address - Phone:850-386-4054
Practice Address - Fax:850-422-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1081-96A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026456300Medicaid
105563Medicare Oscar/Certification