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Organization
INDIAN RIVER RESIDENTIAL CARE COMMUNITY
Active
Organization
INDIAN RIVER RESIDENTIAL CARE COMMUNITY
Active
Other names
dba Indian River Retirement Community, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
GUY S PIERCE (MANAGING MEMBER)
(336) 595-1075
Entity
Organization
Contact information
Practice address
1012 JUSTIS ST, CHESAPEAKE, VA 23325-2516
(757) 523-4659
Mailing address
PO BOX 1487, KERNERSVILLE, NC 27285-1487
(336) 595-1075
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5002281
—
VA
Enumeration date
11/28/2006
Last updated
08/22/2020
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