PHC-Blountstown Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF12870961 Issued in FL

Legal business name

PHC-BLOUNTSTOWN INC

Practice address

17884 NE Crozier St
Blountstown, FL 32424-1050

Phone

(850) 674-5464

Fax

(850) 674-9384

NPI assigned

Nov 1, 2005

Last updated

Jun 17, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

PHC-BLOUNTSTOWN INCAs reported in NPPES

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

Authorized official

Name

Mrs. Catherine A Ates, R.N.

Title

President, Chief Operating Officer

Phone

(850) 682-5322

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

PHC-Blountstown Inc

Locations

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1972594729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 GARDEN GATE CIR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048629",
            "telephone_number": "850-682-5322",
            "fax_number": "850-689-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17884 NE CROZIER ST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241050",
            "telephone_number": "850-674-5464",
            "fax_number": "850-674-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC-BLOUNTSTOWN INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHC-BLOUNTSTOWN INC",
        "enumeration_date": "2005-11-01",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "ATES",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT, CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "850-682-5322",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF12870961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025109700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.