| Organization Name: | CRESCENT BEACH CARE, LLC |
| NPI Number: | 1033451380 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ADRIAN SHANE LONG (MEMBER-MANAGED) |
| Mailing Address: | 6573 A1a S Saint Augustine |
| State: | FL US |
| Postal Code: | 320807504 |
| Phone Number: | 9043427363 |
| Fax Number: | 9043427367 |
| NPI Enumeration Date: | 03/25/2013 |
| NPI Last Update Date: | 05/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | ME109167 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |