=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407361454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUVISTA LIVING AT JUPITER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2017
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 674 PIONEER RD FL 33458
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-9011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-532-1800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 674 PIONEER RD
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-9011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-532-1800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TRICIA L. THACKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-558-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------