Healthcare Provider Details

I. General information

NPI: 1265156731
Provider Name (Legal Business Name): EMPIRE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 SW SAIL TER
PORT ST LUCIE FL
34953-2632
US

IV. Provider business mailing address

817 SW SAIL TER
PORT ST LUCIE FL
34953-2632
US

V. Phone/Fax

Practice location:
  • Phone: 772-249-6923
  • Fax:
Mailing address:
  • Phone: 772-249-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MELANIE ACEVEDO
Title or Position: MANAGER
Credential:
Phone: 772-249-6923