Provider Demographics
NPI:1245237270
Name:MERRITT ISLAND RHF HOUSING, INC
Entity Type:Organization
Organization Name:MERRITT ISLAND RHF HOUSING, INC
Other - Org Name:COURTENAY SPRINGS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-257-5100
Mailing Address - Street 1:1100 S COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3804
Mailing Address - Country:US
Mailing Address - Phone:321-452-1233
Mailing Address - Fax:321-452-7068
Practice Address - Street 1:1100 S COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3804
Practice Address - Country:US
Practice Address - Phone:321-452-1233
Practice Address - Fax:321-452-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11070961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020932500Medicaid
FL105463Medicare Oscar/Certification