NPIMap

Organization Active NPI

Elida M. Reyes-Kerr

Doing business as Glenville Pines ALF

  • Assisted Living Facility
  • Palm Bay, FL
National Provider Identifier
1699114066
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
12126 Issued in FL
Legal business name
ELIDA M. REYES-KERR
Doing business as
Glenville Pines ALF
Practice address
1351 Steele Rd SE
Palm Bay, FL 32909-5332
Phone
(321) 989-7568
NPI assigned
Jun 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elida M Reyes-Kerr
Title
Owner
Phone
(321) 984-7568

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 12126 FL Primary

Addresses

Primary practice location

1351 Steele Rd SE
Palm Bay, FL 32909-5332

Mailing address

1351 Steele Rd SE
Palm Bay, FL 32909-5332
Phone (321) 989-7568

Other identifiers 1

IdentifierTypeStateIssuer
005613700MedicaidFL

Other names 1

  • Glenville Pines ALF Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elida M Reyes-Kerr2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1699114066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 STEELE RD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329095332",
            "telephone_number": "321-989-7568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 STEELE RD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329095332",
            "telephone_number": "321-989-7568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIDA M. REYES-KERR",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "REYES-KERR",
        "authorized_official_first_name": "ELIDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-984-7568"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "12126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005613700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenville Pines ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.