MEDICARE: VENUS HOME HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center
2	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1023701331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENUS HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	4242 SW BALTIC ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4242 SW BALTIC ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3141
Country	:	US
Telephone Number	:	561-507-7567
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ANDERSON MABOUT
Credential	:
Telephone Number	:	561-507-7567

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/27/2023

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Directions to “VENUS HOME HEALTHCARE ” Practice Location

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