Provider Demographics
NPI:1750454781
Name:GERI-CARE ASSISTED LIVING & REHABILITATIVE CENTER
Entity Type:Organization
Organization Name:GERI-CARE ASSISTED LIVING & REHABILITATIVE CENTER
Other - Org Name:COASTAL FIRNESS AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:L
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 1:877 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1827
Practice Address - Country:US
Practice Address - Phone:850-638-8447
Practice Address - Fax:850-638-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686595Medicare ID - Type Unspecified