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General NPI Number Information
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NPI Number | 1184010803
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Entity Type | Organization
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Legal Business Name | PERSONAL TOUCH FAMILY HOME
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 4702 NW EVER RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1314
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Country | US
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Telephone | 772-207-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 4702 NW EVER RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983
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Country | US
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Telephone | 772-207-7103
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MCEWAN
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Credential |
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Telephone | 954-993-7002
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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 | 12647
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License Number State | FL
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