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General NPI Number Information
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NPI Number | 1851728083
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Entity Type | Organization
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Legal Business Name | HOME SWEET HOME OF THE TREASURWE COAST, INC.
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 3201 AVENUE Q
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City | FORT PIERCE
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State | FL
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Zip | 34947
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Country | US
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Telephone | 772-242-1648
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Fax | 772-905-8608
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Provider Business Mailing Address
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Address Line | PO BOX 880956
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City | PORT ST LUCIE
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State | FL
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Zip | 34988-0956
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Country | US
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Telephone | 772-359-9088
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Fax | 772-905-8608
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | DIANE F, REYNOLDS
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Credential |
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Telephone | 772-359-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL 11731
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License Number State | FL
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