Provider Demographics
NPI:1740267814
Name:SUNSHINE REHABILITATION CENTER OF INDIAN RIVER COUNTY, INC.
Entity type:Organization
Organization Name:SUNSHINE REHABILITATION CENTER OF INDIAN RIVER COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-6877
Mailing Address - Street 1:1705 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3641
Mailing Address - Country:US
Mailing Address - Phone:772-562-6877
Mailing Address - Fax:772-562-3153
Practice Address - Street 1:1705 17TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3641
Practice Address - Country:US
Practice Address - Phone:772-562-6877
Practice Address - Fax:772-562-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPTION # HCC26261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR049OtherBC/BS PROVIDER NUMBER
FLR049OtherBC/BS PROVIDER NUMBER