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General NPI Number Information
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NPI Number | 1215926910
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Entity Type | Organization
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Legal Business Name | STACEY HEALTH CARE CENTERS INC RIVERSIDE CARE CENTER
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 899 NW 4TH ST
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City | MIAMI
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State | FL
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Zip | 33128-1309
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Country | US
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Telephone | 305-326-1236
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Fax | 305-326-1647
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Provider Business Mailing Address
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Address Line | 899 NW 4TH ST
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City | MIAMI
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State | FL
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Zip | 33128-1309
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Country | US
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Telephone | 305-326-1236
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Fax | 305-326-1647
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD EUGENE STACEY SR.
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Credential |
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Telephone | 305-326-1236
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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 | SNF1478096
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License Number State | FL
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