Integrity - Crescent Park Village, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10102 Issued in FL

Legal business name

INTEGRITY - CRESCENT PARK VILLAGE, LLC

Practice address

551 Redstone Ave W
Crestview, FL 32536-6435

Phone

(850) 683-3997

NPI assigned

Sep 12, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Swain Short

Title

Cio

Phone

(336) 438-1383

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1396264263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3053 S CHURCH ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272155154",
            "telephone_number": "336-438-1376",
            "fax_number": "336-438-1387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 REDSTONE AVE W",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325366435",
            "telephone_number": "850-683-3997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRITY - CRESCENT PARK VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-12",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "SWAIN",
        "authorized_official_title_or_position": "CIO",
        "authorized_official_telephone_number": "336-438-1383"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL10102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Crestview, FL
• Providers in Crestview, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.