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General NPI Number Information
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NPI Number | 1497349625
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Entity Type | Organization
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Legal Business Name | 1ST LIGHT OF HOPE
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Dates
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Enumeration Date | 02/28/2021
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Last Update Date | 02/28/2021
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Provider Practice Location Address
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Address Line | 118 SW ANDOVER CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-6961
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Country | US
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Telephone | 772-214-5860
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Fax | 800-854-2598
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Provider Business Mailing Address
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Address Line | 4451 SW DARLINGTON ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-7607
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Country | US
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Telephone | 772-214-5860
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Fax | 800-854-2598
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Authorized Official
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Title or Position | OWNER
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Name | MR. DON DURANTE ANDREWS
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Credential |
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Telephone | 772-214-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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