Provider Demographics
NPI:1922258979
Name:COURTYARD REHABILITATION AND NURSING CENTER, LLC
Entity Type:Organization
Organization Name:COURTYARD REHABILITATION AND NURSING CENTER, LLC
Other - Org Name:COURTYARD REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMMELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-233-8800
Mailing Address - Street 1:POST OFFICE BOX 27790
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32411-7790
Mailing Address - Country:US
Mailing Address - Phone:850-233-8800
Mailing Address - Fax:850-235-3232
Practice Address - Street 1:455 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4827
Practice Address - Country:US
Practice Address - Phone:828-252-0099
Practice Address - Fax:828-252-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAPPLIED FOR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility