Rehabilitation Center at Park Place, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

REHABILITATION CENTER AT PARK PLACE, LLC

Practice address

1717 W Avery St
Pensacola, FL 32501-1811

Phone

(850) 434-2355

NPI assigned

Jan 9, 2014

Last updated

May 13, 2014By 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. Gregory Shayne Bench

Title

Cfo

Phone

(941) 758-4745

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1912329913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5265 OFFICE PARK BLVD",
            "address_2": "SUITE 101",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342033441",
            "telephone_number": "941-758-4745",
            "fax_number": "888-391-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W AVERY ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325011811",
            "telephone_number": "850-434-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHABILITATION CENTER AT PARK PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "BENCH",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "SHAYNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "941-758-4745",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0104875-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Pensacola, FL
• Providers in Pensacola, 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 May 13, 2014; 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.