Healthcare Provider Details

I. General information

NPI: 1649674011
Provider Name (Legal Business Name): SALUS ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SW BRIDGEPORT DRIVE
PORT SAINT LUCIE FL
34953
US

IV. Provider business mailing address

457 SW BRIDGEPORT DRIVE
PORT SAINT LUCIE FL
34953
US

V. Phone/Fax

Practice location:
  • Phone: 772-370-8107
  • Fax: 772-237-6051
Mailing address:
  • Phone: 772-370-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAMIANA LOMBARDO-AIKENS
Title or Position: AMBR
Credential:
Phone: 772-370-8107