DEEP CREEK RNC, LLC (NPI# 1679560262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679560262 |
| Entity Type | Organization |
| Organization Name | DEEP CREEK RNC, LLC |
| Other Organization Name | PORT CHARLOTTE REHABILITATION CENTER |
| Practice Address |
25325 Rampart Blvd Port Charlotte FL 33983 |
| Mailing Address |
25325 Rampart Blvd Port Charlotte FL 33983-6404 |
| Practice Telephone | 9416297466 |
| Practice Fax Number | 9416299053 |
| Mailing Telephone | 9416297466 |
| Mailing Fax Number | 9416299053 |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2018-06-12 |
| Authorized Official Name | MR. SAMUEL B KELLETT (MANAGING MEMBER OF SBK CAPITAL LLC) |
| Authorized Official Telephone | 4042337048 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | SNF14260961 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 0319325 00 | 05 | |
| VA | V516P-6820 | 01 |
| Other Name | Type Code |
|---|---|
| Port Charlotte Rehabilitation Center | Doing Business As Name - Organization |
| Street Address |
25325 RAMPART BLVD |
| City | PORT CHARLOTTE |
| State | FL |
| Zip Code | 33983 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700118742 | Luigi Amabile Jr. | Occupational Therapy Assistant | 25325 Rampart Blvd, Port Charlotte, FL 33983-6404 | 2010-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114327244 | Alexandra Fichetti | Counselor | 1196-j Rio De Janeiro. Ave, Punta Gorda, FL 33983 | 2014-08-26 |
| 1164749719 | Larry D. Rand | Physician Assistant | 27289 Voyageur Dr., Punta Gorda, FL 33983 | 2010-04-22 |
| 1912039223 | Wal-mart Stores, Inc. | Technician/Technologist | 375 Kings Highway, Port Charlotte, FL 33983 | 2007-03-12 |
| 1669552360 | Paul Edward Tuma | Pharmacist | 2000 Kings Highway, Port Charlotte, FL 33983 | 2006-10-17 |
| 1013007145 | Amy Louise Houser | Social Worker | 26559 Barraquilla Avenue, Punta Gorda, FL 33983 | 2006-10-12 |
| 1447677208 | Karen Partridge | Pharmacist | 375 Kings Hwy, Wal-mart Pharmacy 3349, Port Charlotte, FL 33983 | 2014-03-18 |
| 1104261650 | North Port Retirement Centers, Inc. | Assisted Living Facility | 24949 Sandhill Blvd, Punta Gorda, FL 33983 | 2013-05-09 |
| 1194864009 | Petrija Jen Do Pa | Personal Emergency Response Attendant | 24451 Sandhill Blvd, Suite A, Punta Gorda, FL 33983 | 2007-02-06 |
| 1518414994 | Kristen Cuellar | Clinic/Center | 2428 Nuremberg Blvd, Punta Gorda, FL 33983-2609 | 2016-09-02 |
| 1457652935 | Aggies's Place, Inc. | In Home Supportive Care | 2428 Nuremberg Blvd., Punta Gorda, FL 33983-2609 | 2010-11-15 |
| Find all providers in zip 33983 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (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. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396754230 | Health Center of Port Charlotte Inc | Skilled Nursing Facility | 4000 Kings Hwy, Port Charlotte, FL 33980-8413 | 2006-08-07 |
| 1043233992 | Port Charlotte Facility Operations, LLC | Skilled Nursing Facility | 18480 Cochran Blvd, Port Charlotte, FL 33948-3379 | 2006-07-25 |
| 1396778825 | Hqm of Port Charlotte, LLC | Skilled Nursing Facility | 4033 Beaver Ln, Port Charlotte, FL 33952-9206 | 2006-07-08 |
| 1740220227 | Tandem Health Care of Port Charlotte, Inc. | Skilled Nursing Facility | 18480 Toledo Blade Blvd, Port Charlotte, FL 33948-3379 | 2006-06-07 |
| 1124002647 | Peace River Hma Nursing Center Inc | Skilled Nursing Facility | 2370 Harbor Blvd, Port Charlotte, FL 33952 | 2005-11-30 |
| 1275904864 | Solaris Healthcare Charlotte Harbor LLC | Skilled Nursing Facility | 4000 Kings Hwy, Port Charlotte, FL 33980-8718 | 2015-10-08 |
| 1033586060 | Mary Samoge-wismer | Skilled Nursing Facility | 18480 Cochran Blvd, Port Charlotte, FL 33948-3379 | 2015-08-25 |
| 1376957803 | Ccrc - South Port Square, LLC | Skilled Nursing Facility | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2014-06-12 |
| 1467761783 | Charlotte Harbor Rehab LLC | Skilled Nursing Facility | 4000 Kings Hwy, Port Charlotte, FL 33980-8718 | 2010-10-04 |
| 1801062880 | Village Place Nh LLC | Skilled Nursing Facility | 2370 Harbor Blvd, Port Charlotte, FL 33952-5024 | 2008-04-30 |
| Find all providers in PORT CHARLOTTE | ||||
| City | PORT CHARLOTTE |
| Zip Code | 33983 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.