Healthcare Provider Details

I. General information

NPI: 1164410197
Provider Name (Legal Business Name): INDIAN RIVER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 GREENBORO DR
WEST MELBOURNE FL
32904-1698
US

IV. Provider business mailing address

7201 GREENBORO DR
WEST MELBOURNE FL
32904-1698
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-0990
  • Fax: 321-951-4553
Mailing address:
  • Phone: 321-727-0990
  • Fax: 321-951-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1348096
License Number StateFL

VIII. Authorized Official

Name: MRS. MONICA TERRANO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 819-852-7000