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Organization

MELBOURNE TERRACE RCC, LLC

Active
Other names
Melbourne Terrace Rehabilitation Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SAMUEL B KELLETT (AS SOLE MEMBER OF SBK CAPITAL LLC)
(404) 233-7048
Entity
Organization

Contact information

Practice address
251 E FLORIDA AVE, MELBOURNE, FL 32901-8303
(321) 725-3990
(321) 725-4099
Mailing address
251 E FLORIDA AVE, MELBOURNE, FL 32901-8303
(321) 725-3990
(321) 725-4099

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF13400962
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
026454700
FL
01
V673P-5337
VA
Enumeration date
09/29/2005
Last updated
01/30/2009
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