Provider Demographics
NPI:1154305688
Name:COMMUNITY HEALTH AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:850-747-9688
Mailing Address - Street 1:3611 TRANSMITTER RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9799
Mailing Address - Country:US
Mailing Address - Phone:850-747-9688
Mailing Address - Fax:850-747-9992
Practice Address - Street 1:3611 TRANSMITTER RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-9799
Practice Address - Country:US
Practice Address - Phone:850-747-9688
Practice Address - Fax:850-747-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9FOtherBC/BS
FLL9FOtherBC/BS