Provider Demographics
NPI:1457864357
Name:CRESTVIEW HOSPITAL COMPANY, LLC
Entity Type:Organization
Organization Name:CRESTVIEW HOSPITAL COMPANY, LLC
Other - Org Name:NORTH OKALOOSA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:151 E REDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5352
Mailing Address - Country:US
Mailing Address - Phone:850-689-8100
Mailing Address - Fax:850-689-8484
Practice Address - Street 1:151 E REDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5352
Practice Address - Country:US
Practice Address - Phone:850-689-8100
Practice Address - Fax:850-689-8484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESTVIEW HOSPITAL COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-14
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit