Healthcare Provider Details

I. General information

NPI: 1740267814
Provider Name (Legal Business Name): SUNSHINE REHABILITATION CENTER OF INDIAN RIVER COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 17TH AVE
VERO BEACH FL
32960-3641
US

IV. Provider business mailing address

1705 17TH AVE
VERO BEACH FL
32960-3641
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6877
  • Fax: 772-562-3153
Mailing address:
  • Phone: 772-562-6877
  • Fax: 772-562-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberEXEMPTION # HCC26
License Number StateFL

VIII. Authorized Official

Name: MRS. KATRENA MCMAHAN
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 772-562-6877