Provider Demographics
NPI:1356634604
Name:INDIAN RIVER HOME CARE, INC.
Entity type:Organization
Organization Name:INDIAN RIVER HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:772-766-9275
Mailing Address - Street 1:65 ROYAL PALM POINT
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4259
Mailing Address - Country:US
Mailing Address - Phone:772-766-9275
Mailing Address - Fax:
Practice Address - Street 1:65 ROYAL PALM PT
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4259
Practice Address - Country:US
Practice Address - Phone:772-766-9275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health