Provider Demographics
NPI:1245442912
Name:RIVERS EDGE ADULT DAY CARE INCORPORATED
Entity type:Organization
Organization Name:RIVERS EDGE ADULT DAY CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:THESLYN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER-OPPERATOR
Authorized Official - Phone:321-727-7337
Mailing Address - Street 1:422 MARTIN RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-3923
Mailing Address - Country:US
Mailing Address - Phone:321-727-7337
Mailing Address - Fax:321-727-8970
Practice Address - Street 1:422 MARTIN RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3923
Practice Address - Country:US
Practice Address - Phone:321-727-7337
Practice Address - Fax:321-727-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112311Z00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684759500Medicaid