Provider Demographics
NPI:1952835712
Name:COCOA RIVER THERAPY, LLC
Entity Type:Organization
Organization Name:COCOA RIVER THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:FANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-279-1134
Mailing Address - Street 1:1835 NE MIAMI GARDENS DR STE 157
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5035
Mailing Address - Country:US
Mailing Address - Phone:786-279-1134
Mailing Address - Fax:786-513-2499
Practice Address - Street 1:700 S 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3626
Practice Address - Country:US
Practice Address - Phone:786-279-1134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation