Healthcare Provider Details

I. General information

NPI: 1023701331
Provider Name (Legal Business Name): VENUS HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 SW BALTIC ST
PORT SAINT LUCIE FL
34953-3141
US

IV. Provider business mailing address

4242 SW BALTIC ST
PORT SAINT LUCIE FL
34953-3141
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-7567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDERSON MABOUT
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-507-7567