MEDICARE: AURORA OF THE TREASURE COAST

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073662375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA OF THE TREASURE COAST

Provider Business Mailing Address
First Line	:	325 FARLEYS CT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-9449
Country	:	US
Telephone Number	:	772-460-0809
Fax Number	:	772-489-5986

Provider Business Practice Location Address
First Line	:	6609 N US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-7409
Country	:	US
Telephone Number	:	772-460-0809
Fax Number	:	772-489-5986

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MARIA STELLA NIEMI
Credential	:
Telephone Number	:	772-460-0809

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/22/2020

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