Healthcare Provider Details

I. General information

NPI: 1245237270
Provider Name (Legal Business Name): MERRITT ISLAND RHF HOUSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S COURTENAY PKWY
MERRITT ISLAND FL
32952-3804
US

IV. Provider business mailing address

1100 S COURTENAY PKWY
MERRITT ISLAND FL
32952-3804
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-1233
  • Fax: 321-452-7068
Mailing address:
  • Phone: 321-452-1233
  • Fax: 321-452-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF11070961
License Number StateFL

VIII. Authorized Official

Name: STUART HARTMAN
Title or Position: VP OF OPERATIONS
Credential:
Phone: 562-257-5100