MEDICARE: P & P GROUP HOME, LLC

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

General Provider Information

NPI Number	:	1679421341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P & P GROUP HOME, LLC

Provider Business Mailing Address
First Line	:	2156 SE STARGRASS ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-4728
Country	:	US
Telephone Number	:	561-654-6764
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 SE STARGRASS ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-4728
Country	:	US
Telephone Number	:	561-654-6764
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RUDNELL POTTER
Credential	:
Telephone Number	:	561-654-6764

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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