Healthcare Provider Details

I. General information

NPI: 1598876088
Provider Name (Legal Business Name): HOSPICE OF THE TREASURE COAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000-5090 DUNN ROAD
FORT PIERCE FL
34981
US

IV. Provider business mailing address

1201 SE INDIAN STREET
STUART FL
34997
US

V. Phone/Fax

Practice location:
  • Phone: 772-462-8999
  • Fax: 772-781-8723
Mailing address:
  • Phone: 772-403-4500
  • Fax: 772-781-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number5033096
License Number StateFL

VIII. Authorized Official

Name: MRS. JACKIE KENDRICK
Title or Position: CEO
Credential:
Phone: 772-403-4500