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General NPI Number Information
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NPI Number | 1730580648
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Entity Type | Organization
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Legal Business Name | COTIN-VALCIN, CHARITE ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 238 NW FERRIS DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1121
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Country | US
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Telephone | 772-985-4122
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Fax | 772-777-3227
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Provider Business Mailing Address
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Address Line | 238 NW FERRIS DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1121
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Country | US
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Telephone | 772-985-4122
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Fax | 772-777-3227
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | CHARITE VALCIN-COTIN
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Credential |
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Telephone | 772-985-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906704
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License Number State | FL
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