Provider Demographics
NPI:1124028063
Name:THE HEALTH CENTER OF MERRITT ISLAND INC
Entity Type:Organization
Organization Name:THE HEALTH CENTER OF MERRITT ISLAND INC
Other - Org Name:THE HEALTH CENTER OF MERRITT ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:FRASHER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:321-454-4035
Mailing Address - Street 1:500 CROCKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-5034
Mailing Address - Country:US
Mailing Address - Phone:321-454-4035
Mailing Address - Fax:321-453-0280
Practice Address - Street 1:500 CROCKETT BLVD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-5034
Practice Address - Country:US
Practice Address - Phone:321-454-4035
Practice Address - Fax:321-453-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1365096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022670000Medicaid
FL022670000Medicaid