Regency Care of Blountstown, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1652096 Issued in FL

Legal business name

REGENCY CARE OF BLOUNTSTOWN, LLC

Doing business as

Blountstown Health & Rehabilitation Center

Practice address

16690 SW Chipola Rd
Blountstown, FL 32424-1953

Phone

(850) 674-4311

Fax

(850) 874-3798

NPI assigned

Sep 22, 2005

Last updated

Apr 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Steven D Womack, CPA

Title

Managing Member

Phone

(828) 381-5360

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Blountstown Health & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1871589093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1667",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286031667",
            "telephone_number": "828-324-8898",
            "fax_number": "828-322-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16690 SW CHIPOLA RD",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241953",
            "telephone_number": "850-674-4311",
            "fax_number": "850-874-3798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY CARE OF BLOUNTSTOWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "WOMACK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "828-381-5360",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1652096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY MDS ID NUM",
            "identifier": "35960874",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002298700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE SNF LICENSE NUMBER",
            "identifier": "SNF1652096",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blountstown Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessie W Pippin
• Jon Mark Plummer, R.PH.
• Cindy Mears Porter, ARNP
• Alecia Presbitero, RBT
• Madelyn Shiplov Price, MCD/CCC-SLP
• Jarom Arthur Ricks, OTR/L
• Brittany L Riddle
• Rivertown Assisted Living LLC
• Rivertown Transitional Care LLC
• Sarah Roper

• Skilled Nursing Facility in Blountstown, FL
• Providers in Blountstown, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.