MEDICARE: COMFORT RESIDENTIAL HOMES 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1790471621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT RESIDENTIAL HOMES LLC

Provider Business Mailing Address
First Line	:	1807 FULTON DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-3939
Country	:	US
Telephone Number	:	772-828-6496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 FULTON DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-3939
Country	:	US
Telephone Number	:	772-828-6496
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CRYSTAL HILLS
Credential	:
Telephone Number	:	772-828-6496

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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