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General NPI Number Information
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NPI Number | 1063019693
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Entity Type | Organization
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Legal Business Name | FRONT PORCH NURSE REGISTRY LLC
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1680 SW BAYSHORE BLVD STE 112
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-3518
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Country | US
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Telephone | 954-655-9682
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 882012
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City | PORT ST LUCIE
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State | FL
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Zip | 34988-2012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DARLENE DESSOURCES
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Credential |
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Telephone | 954-566-9682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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