Provider Demographics
NPI:1518990753
Name:NRV ENTERPRISES INC
Entity Type:Organization
Organization Name:NRV ENTERPRISES INC
Other - Org Name:FUNCTIONAL REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ASUMBRADO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:863-385-6119
Mailing Address - Street 1:4141 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2131
Mailing Address - Country:US
Mailing Address - Phone:863-385-6119
Mailing Address - Fax:863-385-9698
Practice Address - Street 1:4141 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2131
Practice Address - Country:US
Practice Address - Phone:863-385-6119
Practice Address - Fax:863-385-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106953261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8BOtherBCBSF
FL883844500Medicaid
FL106953Medicare Oscar/Certification