Healthcare Provider Details

I. General information

NPI: 1336095405
Provider Name (Legal Business Name): CONCORDIS ALF STUART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SE PALM BEACH RD
STUART FL
34994-4012
US

IV. Provider business mailing address

3724 JEFFERSON ST STE 317
AUSTIN TX
78731-6222
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-7133
  • Fax: 772-463-7136
Mailing address:
  • Phone: 352-229-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS WATKINS
Title or Position: CFO
Credential:
Phone: 352-229-3263