=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891549523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLOMON'S PORCH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2024
-----------------------------------------------------
Last Update Date | 04/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2736 SENECA AVE
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34946-6666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-706-9757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2736 SENECA AVE
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34946-6666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-706-9757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARETAKER
-----------------------------------------------------
Name | VITTORIO MORBETH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-706-9757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------