=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316885403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALITY OASIS ALF LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2026
-----------------------------------------------------
Last Update Date | 03/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 SW SUDDER AVE
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34953-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-207-7947
-----------------------------------------------------
Fax | 772-408-0969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11380 SW HILLCREST CIR
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34987-2704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-940-9219
-----------------------------------------------------
Fax | 772-408-0969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDRE J DORVAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-940-9219
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------