=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073662375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURORA OF THE TREASURE COAST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6609 N US HIGHWAY 1
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34946-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-460-0809
-----------------------------------------------------
Fax | 772-489-5986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 FARLEYS CT
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32968-9449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-460-0809
-----------------------------------------------------
Fax | 772-489-5986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. MARIA STELLA NIEMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-460-0809
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------