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General NPI Number Information
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NPI Number | 1821343740
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Entity Type | Organization
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Legal Business Name | THE GIFT HOUSE INC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 259 NE AIROSO BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1675
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Country | US
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Telephone | 877-589-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 259 NE AIROSO BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1675
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Country | US
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Telephone | 877-589-3036
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CARMEN IVETTE AYUSO
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Credential |
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Telephone | 877-589-3036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | H11000058533
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License Number State | FL
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