Provider Demographics
NPI:1922860535
Name:CENTERLINE HEALTHCARE LLC
Entity Type:Organization
Organization Name:CENTERLINE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-202-8519
Mailing Address - Street 1:8404 WARNER PL
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-4994
Mailing Address - Country:US
Mailing Address - Phone:575-202-8519
Mailing Address - Fax:
Practice Address - Street 1:8404 WARNER PL
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-4994
Practice Address - Country:US
Practice Address - Phone:575-202-8519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty