MEDICARE: SHARING FACILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL11722	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821308826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARING FACILITY

Provider Business Mailing Address
First Line	:	2897 HARSON WAY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-6709
Country	:	US
Telephone Number	:	772-370-6765
Fax Number	:	772-464-2112

Provider Business Practice Location Address
First Line	:	2897 HARSON WAY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-6709
Country	:	US
Telephone Number	:	772-370-6765
Fax Number	:	772-464-2112

Authorized Official
Title or Position	:	ADMIN
Name	:	MRS. ANGEL L COX
Credential	:
Telephone Number	:	772-370-6765

Provider Enumeration Date	:	10/09/2010
Last Update Date	:	10/09/2010

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Directions to “SHARING FACILITY ” Practice Location

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