MEDICARE: RIVERS EDGE ADULT DAY CARE INCORPORATED

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	311Z00000X	Custodial Care Facility	9112	FL
2	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245442912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERS EDGE ADULT DAY CARE INCORPORATED

Provider Business Mailing Address
First Line	:	422 MARTIN RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-3923
Country	:	US
Telephone Number	:	321-727-7337
Fax Number	:	321-727-8970

Provider Business Practice Location Address
First Line	:	422 MARTIN RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-3923
Country	:	US
Telephone Number	:	321-727-7337
Fax Number	:	321-727-8970

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YVONNE THESLYN WILLIAMS
Credential	:	OWNER-OPPERATOR
Telephone Number	:	321-727-7337

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/10/2024

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