Organization
IMMACULATE ADULT DAY CARE LLC
Active
Other names
Senior Care of Brevard
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOY RUTHERFORD APRN,MSN (CEO)
(321) 631-9014
Entity
Organization
Contact information
Practice address
234 WILLARD ST STE A, COCOA, FL 32922-7984
(321) 631-9014
(321) 631-8010
Mailing address
234 WILLARD ST STE A, COCOA, FL 32922-7984
(321) 631-9014
(321) 631-8010
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105066100
—
FL
Enumeration date
08/14/2019
Last updated
01/27/2020
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