| Organization Name: | FORT PIERCE INTERMEDIATE CARE CENTER |
| NPI Number: | 1184753758 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRAIG WALKER (VP) |
| Mailing Address: | 900 Virginia Ave Suite 10 Fort Pierce |
| State: | FL US |
| Postal Code: | 349825882 |
| Phone Number: | 7724646551 |
| Fax Number: | 7724650322 |
| NPI Enumeration Date: | 03/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |