Provider Demographics
NPI:1659364438
Name:HEALTH CENTER OF DAYTONA BEACH, INC
Entity Type:Organization
Organization Name:HEALTH CENTER OF DAYTONA BEACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:386-257-6362
Mailing Address - Street 1:550 NATIONAL HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1494
Mailing Address - Country:US
Mailing Address - Phone:386-257-6362
Mailing Address - Fax:386-257-1783
Practice Address - Street 1:550 NATIONAL HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1494
Practice Address - Country:US
Practice Address - Phone:386-257-6362
Practice Address - Fax:386-257-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF 1645096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL5UOtherBLUE CROSS PROVIDER #
FL022909100Medicaid
FL022909100Medicaid