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General NPI Number Information
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NPI Number | 1841341070
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER COORDINATORS, INC.
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 320 21ST CT SW
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City | VERO BEACH
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State | FL
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Zip | 32962-3368
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Country | US
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Telephone | 772-567-3568
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Fax | 772-562-9720
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Provider Business Mailing Address
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Address Line | 328 NW SHORELINE CIR
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2913
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Country | US
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Telephone | 772-626-8503
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Fax | 772-343-1959
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DENNISE KING
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Credential |
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Telephone | 772-567-3568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | FL
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