Provider Demographics
NPI:1790325421
Name:INDIAN RIVER COUNTY HEALTHY START COALITION, INC
Entity Type:Organization
Organization Name:INDIAN RIVER COUNTY HEALTHY START COALITION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MNM
Authorized Official - Phone:772-563-9118
Mailing Address - Street 1:1555 INDIAN RIVER BLVD STE B241
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7119
Mailing Address - Country:US
Mailing Address - Phone:772-563-9118
Mailing Address - Fax:
Practice Address - Street 1:1555 INDIAN RIVER BLVD STE B241
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7119
Practice Address - Country:US
Practice Address - Phone:772-563-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No251300000XAgenciesLocal Education Agency (LEA)
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty