Sacred Heart on the Gulf

Primary specialty

Rehabilitation HospitalTaxonomy code 283X00000X

License

PT27432 Issued in FL

Legal business name

SACRED HEART ON THE GULF

Practice address

3801 E Highway 98
Port St Joe, FL 32456-5318

Phone

(850) 229-5752

Fax

(850) 227-7999

NPI assigned

Feb 8, 2013

Last updated

Feb 8, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

SACRED HEART HEALTH SYSTEMAs reported in NPPES

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

Authorized official

Name

Miss Jose Aurelio Santiesteban

Title

Rehab. Manager

Phone

(850) 229-5752

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Sacred Heart Hospital

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

{
    "created_epoch": "1360281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360281600000",
    "number": "1508105610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 E HIGHWAY 98",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324565318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 E HIGHWAY 98",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324565318",
            "telephone_number": "850-229-5752",
            "fax_number": "850-227-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART ON THE GULF",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SACRED HEART HEALTH SYSTEM",
        "enumeration_date": "2013-02-08",
        "last_updated": "2013-02-08",
        "status": "A",
        "authorized_official_last_name": "SANTIESTEBAN",
        "authorized_official_first_name": "JOSE AURELIO",
        "authorized_official_title_or_position": "REHAB. MANAGER",
        "authorized_official_telephone_number": "850-229-5752",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "FL",
            "license": "PT27432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002012700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Rehab Management, LLC
• Shameka Ashawn Raines
• Judith Renfroe Romiti, RN
• Jeffrey Robert Root, M.D.
• Heidi S Rosasco, PT
• Sacred Heart on the Gulf
• Salt and Ivy Gulf LLC (Salt and Ivy Health and Wellness)
• Braden J Shaffer, APN
• Shivam Shah, MD
• Leo Haywood Shealy, LMHC

• Rehabilitation Hospital in Port St Joe, FL
• Providers in Port St Joe, FL by specialty
• Rehabilitation Hospital in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; 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.