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General NPI Number Information
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NPI Number | 1164410197
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER CENTER, LLC
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 7201 GREENBORO DR
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1698
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Country | US
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Telephone | 321-727-0990
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Fax | 321-951-4553
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Provider Business Mailing Address
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Address Line | 7201 GREENBORO DR
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1698
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Country | US
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Telephone | 321-727-0990
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Fax | 321-951-4553
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. MONICA TERRANO
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Credential |
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Telephone | 819-852-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1348096
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License Number State | FL
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