| Organization Name: | 195 MATTIE M KELLY BOULEVARD |
| NPI Number: | 1336418102 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HUBERT PAUL (MANAGER) |
| Mailing Address: | 195 Mattie M Kelly Blvd Destin |
| State: | FL US |
| Postal Code: | 325412811 |
| Phone Number: | 8506544588 |
| Fax Number: | 8506543944 |
| NPI Enumeration Date: | 12/22/2011 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 314000000X |
| License Number: | SNF16210961 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Skilled Nursing Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |