MEDICARE: CHILDRENS HOME SOCIETY 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194012252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS HOME SOCIETY TREASURE COAST

Provider Business Mailing Address
First Line	:	1485 S SEMORAN BLVD
Second Line	:	SUITE 1448
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5533
Country	:	US
Telephone Number	:	321-397-3000
Fax Number	:	321-397-3016

Provider Business Practice Location Address
First Line	:	590 NW PEACOCK BLVD
Second Line	:	SUITE 9
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2213
Country	:	US
Telephone Number	:	772-344-4020
Fax Number	:	772-344-4038

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID A BUNDY
Credential	:	CEO
Telephone Number	:	321-397-3000

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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