=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598876088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPICE OF THE TREASURE COAST INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000-5090 DUNN ROAD
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-462-8999
-----------------------------------------------------
Fax | 772-781-8723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 SE INDIAN STREET
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-403-4500
-----------------------------------------------------
Fax | 772-781-8423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. JACKIE KENDRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-403-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 5033096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------