Basic Information
| Provider Information | |||||||||
| NPI: | 1023034360 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRNC, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH FLORIDA REHABILITATION AND NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2979 PGA BLVD | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334102911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616270664 | ||||||||
| FaxNumber: | 5616272867 | ||||||||
| Practice Location | |||||||||
| Address1: | 1083 SANDERS AVE | ||||||||
| Address2: | |||||||||
| City: | GRACEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324401854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502634447 | ||||||||
| FaxNumber: | 8502634201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | KLEISER | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIT & REIMBURSEMENT SR. ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 5616270664 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | SNF1253096 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.