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General NPI Number Information
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NPI Number | 1245442912
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Entity Type | Organization
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Legal Business Name | RIVERS EDGE ADULT DAY CARE INCORPORATED
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 422 MARTIN RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-3923
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Country | US
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Telephone | 321-727-7337
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Fax | 321-727-8970
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Provider Business Mailing Address
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Address Line | 422 MARTIN RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-3923
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Country | US
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Telephone | 321-727-7337
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Fax | 321-727-8970
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Authorized Official
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Title or Position | DIRECTOR
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Name | YVONNE THESLYN WILLIAMS
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Credential | OWNER-OPPERATOR
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Telephone | 321-727-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 9112
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 684759500
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 684759500
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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