| NPI | 1104926401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY VARNADOE Chief Executive Officer 904-259-3151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 282NR1301X General Acute Care Hospital, Rural (Licence: FL 4152) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: FL SNF1581096) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH13709) | |
| 3336I0012X Pharmacy, Institutional Pharmacy (Licence: FL PH9039) | |
| 3336I0012X Pharmacy, Institutional Pharmacy (Licence: FL PH13710) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2021-06-21 |