Provider Demographics
NPI:1558318576
Name:INDIAN RIVER CARDIAC REHAB INC
Entity Type:Organization
Organization Name:INDIAN RIVER CARDIAC REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:CELANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-778-7604
Mailing Address - Street 1:1500 36TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4887
Mailing Address - Country:US
Mailing Address - Phone:772-778-7604
Mailing Address - Fax:772-778-3251
Practice Address - Street 1:1500 36TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4887
Practice Address - Country:US
Practice Address - Phone:772-778-7604
Practice Address - Fax:772-778-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77428Medicare ID - Type Unspecified