=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477923654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBRACE ADULT FAMILY CARE HOME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2015
-----------------------------------------------------
Last Update Date | 08/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1737 SW BRADWAY LN
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34953-1680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-800-7620
-----------------------------------------------------
Fax | 772-607-5002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1737 SW BRADWAY LANE
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-800-7620
-----------------------------------------------------
Fax | 772-607-5002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MARIE-MARTHE JOSEPH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-800-7620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------