Healthcare Provider Details

I. General information

NPI: 1225896996
Provider Name (Legal Business Name): ANCHORS AWAY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4981 SE GRAHAM DR
STUART FL
34997-1554
US

IV. Provider business mailing address

3100 SE FEDERAL HWY # 1010
STUART FL
34994-5531
US

V. Phone/Fax

Practice location:
  • Phone: 786-416-5263
  • Fax:
Mailing address:
  • Phone: 786-416-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMMY LOPEZ
Title or Position: MANAGER
Credential:
Phone: 786-416-5263