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General NPI Number Information
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NPI Number | 1063057255
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Entity Type | Organization
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Legal Business Name | K AND L LOVING CARE OF PORT SAINT LUCIE II ASSISTED LIVING FACILITY IN
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 1243 SW FOX CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-6863
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Country | US
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Telephone | 561-628-8075
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 ASPEN LEAF DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-1713
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Country | US
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Telephone | 561-628-8075
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LOTOYA HIBBERT
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Credential |
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Telephone | 561-628-8075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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