Provider Demographics
NPI:1124216239
Name:GERI CARE ASSISTED LIVING AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:GERI CARE ASSISTED LIVING AND REHABILITATION CENTER
Other - Org Name:BEACON HILL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-674-7639
Mailing Address - Street 1:17352 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-1763
Mailing Address - Country:US
Mailing Address - Phone:850-674-7639
Mailing Address - Fax:850-674-4305
Practice Address - Street 1:180 LIGHTKEEPERS DR
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-6173
Practice Address - Country:US
Practice Address - Phone:850-647-2600
Practice Address - Fax:850-647-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL421310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890143100Medicaid