MEDICARE: RAI CARE CENTERS OF FLORIDA I, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V1U	OTHER	FL	BCBS
2	7405840	OTHER	FL	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083623078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAI CARE CENTERS OF FLORIDA I, LLC

Provider Business Mailing Address
First Line	:	8661 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3331
Country	:	US
Telephone Number	:	772-807-7229
Fax Number	:	772-807-7266

Provider Business Practice Location Address
First Line	:	8661 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3331
Country	:	US
Telephone Number	:	772-807-7229
Fax Number	:	772-807-7266

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BARRY L. BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	10/17/2023

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