MEDICARE: ELIDA M. REYES-KERR

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	310400000X	Assisted Living Facility	12126	FL

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	:	1699114066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIDA M. REYES-KERR

Provider Business Mailing Address
First Line	:	1351 STEELE RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5332
Country	:	US
Telephone Number	:	321-989-7568
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 STEELE RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5332
Country	:	US
Telephone Number	:	321-989-7568
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIDA M REYES-KERR
Credential	:
Telephone Number	:	321-984-7568

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	06/19/2013

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