Healthcare Provider Details

I. General information

NPI: 1447597463
Provider Name (Legal Business Name): AMORE AT KANNER HIGHWAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 S KANNER HWY
STUART FL
34994-7152
US

IV. Provider business mailing address

1634 S KANNER HWY
STUART FL
34994-7152
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-8989
  • Fax:
Mailing address:
  • Phone: 772-219-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9636
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL9636
License Number StateFL

VIII. Authorized Official

Name: MR. MEIR COSIOL
Title or Position: MANAGER
Credential:
Phone: 772-219-8989