Healthcare Provider Details

I. General information

NPI: 1003094202
Provider Name (Legal Business Name): NRV ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SUN N LAKE BLVD
SEBRING FL
33872-2131
US

IV. Provider business mailing address

4141 SUN N LAKE BLVD
SEBRING FL
33872-2131
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-6119
  • Fax:
Mailing address:
  • Phone: 863-385-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NOSTER R VILLAMOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 863-465-4412