INDIAN RIVER RESIDENTIAL CARE COMMUNITY
Adult Care Home
Chesapeake, Virginia
Provider NPI: 1578639654
Organization Information:Organization Name: INDIAN RIVER RESIDENTIAL CARE COMMUNITY
Practice Location:
1012 JUSTIS ST CHESAPEAKE, VA 23325 US
Tel: 757-523-4659 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1012 JUSTIS ST CHESAPEAKE, VA 23325 US
Tel: 757-523-4659 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | VA |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
5002281 | VA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin