Healthcare Provider Details

I. General information

NPI: 1245755966
Provider Name (Legal Business Name): VEDADEVI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 SE FACULTY CT
PORT ST LUCIE FL
34952-7603
US

IV. Provider business mailing address

765 E PRIMA VISTA BLVD
PORT ST LUCIE FL
34952-2273
US

V. Phone/Fax

Practice location:
  • Phone: 561-427-9698
  • Fax:
Mailing address:
  • Phone: 15614279698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. MOHANDAI MAHASE
Title or Position: OWNER
Credential:
Phone: 561-427-9698