MEDICARE: TRANSITIONCARE ALF

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	310400000X	Assisted Living Facility	A11948	FL

General Provider Information

NPI Number	:	1083051031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONCARE ALF

Provider Business Mailing Address
First Line	:	1613 SW MERIDIAN AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4300
Country	:	US
Telephone Number	:	772-408-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 SW MERIDIAN AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4300
Country	:	US
Telephone Number	:	772-408-6677
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PAULINE CELETA MIHALOW
Credential	:	7722246091
Telephone Number	:	772-224-6091

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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