Healthcare Provider Details

I. General information

NPI: 1053823252
Provider Name (Legal Business Name): CONTRACTORS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 SE BELFAST AVE
PORT SAINT LUCIE FL
34983-3914
US

IV. Provider business mailing address

926 SE BELFAST AVE
PORT SAINT LUCIE FL
34983-3914
US

V. Phone/Fax

Practice location:
  • Phone: 772-924-5773
  • Fax: 772-264-7865
Mailing address:
  • Phone: 772-924-5773
  • Fax: 772-264-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JILLIAN RICARD
Title or Position: OWNER
Credential:
Phone: 772-924-5773