Provider Demographics
NPI:1376533174
Name:CITY OF MARIANNA OFFICE OF CITY CLERK
Entity Type:Organization
Organization Name:CITY OF MARIANNA OFFICE OF CITY CLERK
Other - Org Name:MARIANNA HEALTH AND REHABILITATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:850-482-8091
Mailing Address - Street 1:4295 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2176
Mailing Address - Country:US
Mailing Address - Phone:850-482-8091
Mailing Address - Fax:850-482-6162
Practice Address - Street 1:4295 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2176
Practice Address - Country:US
Practice Address - Phone:850-482-8091
Practice Address - Fax:850-482-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1322096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020347500Medicaid
FL020347500Medicaid
FL105637Medicare Oscar/Certification