Provider Demographics
NPI:1346296985
Name:CROSS CREEK HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:CROSS CREEK HEALTH CARE ASSOCIATES LLC
Other - Org Name:UNIVERSITY HILLS HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ENFINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-474-0570
Mailing Address - Street 1:10040 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5499
Mailing Address - Country:US
Mailing Address - Phone:850-474-0570
Mailing Address - Fax:850-479-4328
Practice Address - Street 1:10040 HILLVIEW RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5499
Practice Address - Country:US
Practice Address - Phone:850-474-0570
Practice Address - Fax:850-479-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1111096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025212300Medicaid
105445Medicare Oscar/Certification