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General NPI Number Information
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NPI Number | 1235495086
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Entity Type | Organization
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Legal Business Name | THE CORNERSTONES OF PORT ST. LUCIE, INC.
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 1910 SE RAINIER RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7610
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Country | US
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Telephone | 772-337-4321
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Fax | 772-777-1159
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Provider Business Mailing Address
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Address Line | 1102 SW IVANHOE ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-2542
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Country | US
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Telephone | 772-879-4950
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. RINA AIKENS-ABSALOM
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Credential |
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Telephone | 772-370-8107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 12131
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12131
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License Number State | FL
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