Healthcare Provider Details

I. General information

NPI: 1366785297
Provider Name (Legal Business Name): RMD SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 COUNTRY CLUB DR
TITUSVILLE FL
32780-5346
US

IV. Provider business mailing address

1832 COUNTRY CLUB DRIVE
TITUSVILLE FL
32780
US

V. Phone/Fax

Practice location:
  • Phone: 321-383-3531
  • Fax: 321-383-3532
Mailing address:
  • Phone: 321-696-2191
  • Fax: 321-383-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10800
License Number StateFL

VIII. Authorized Official

Name: MR. REX DAVADILLA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 321-696-2191