Organization
STACEY HEALTH CARE CENTERS INC RIVERSIDE CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD EUGENE STACEY SR. (PRESIDENT)
(305) 326-1236
Entity
Organization
Contact information
Practice address
899 NW 4TH ST, MIAMI, FL 33128-1309
(305) 326-1236
(305) 326-1647
Mailing address
899 NW 4TH ST, MIAMI, FL 33128-1309
(305) 326-1236
(305) 326-1647
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1478096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020727600
—
FL
Enumeration date
10/17/2005
Last updated
09/10/2024
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