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INDIAN RIVER RESIDENTIAL CARE COMMUNITY NPI 1578639654


NPI Information

NPI: 1578639654
Provider Name: INDIAN RIVER RESIDENTIAL CARE COMMUNITY

Doing Business As: DBA INDIAN RIVER RETIREMENT COMMUNITY, LLC

Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
1012 JUSTIS ST
CHESAPEAKE, VA
ZIP 23325
Phone: (757) 523-4659
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INDIAN RIVER RESIDENTIAL CARE COMMUNITY is an adult care home custodial care facility in Chesapeake, VA. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. INDIAN RIVER RESIDENTIAL CARE COMMUNITY NPI is 1578639654. The provider is registered as an organization entity type.
The provider Is Doing Business As Dba Indian River Retirement Community, Llc.

The provider's business location address is:

1012 JUSTIS ST
CHESAPEAKE, VA
ZIP 23325-516
Phone: (757) 523-4659

The provider's authorized official is Guy S Pierce .
The authorized official title is Managing Member and has the following contact phone number (336) 595-1075.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1311ZA0620XCustodial Care FacilityAdult Care HomeVIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15002281MEDICAIDVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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