Healthcare Provider Details

I. General information

NPI: 1104360098
Provider Name (Legal Business Name): PSL REHABILITATION AND HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 OLEANDER AVE
PORT ST LUCIE FL
34952
US

IV. Provider business mailing address

7300 OLEANDER AVE
PORT ST LUCIE FL
34952-8221
US

V. Phone/Fax

Practice location:
  • Phone: 772-466-4100
  • Fax: 772-466-4135
Mailing address:
  • Phone: 772-466-4100
  • Fax: 772-466-4135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1452096
License Number StateFL

VIII. Authorized Official

Name: MS. LYNN GRIGGS
Title or Position: VP OF REIMBURSEMENT
Credential:
Phone: 305-770-6144