Provider Demographics
NPI:1992843361
Name:INDIAN RIVER COORDINATORS
Entity Type:Organization
Organization Name:INDIAN RIVER COORDINATORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:772-567-3568
Mailing Address - Street 1:320 21ST CT SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-3368
Mailing Address - Country:US
Mailing Address - Phone:772-567-3568
Mailing Address - Fax:772-562-9720
Practice Address - Street 1:320 21ST CT SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-3368
Practice Address - Country:US
Practice Address - Phone:772-567-3568
Practice Address - Fax:772-562-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty