MEDICARE: SOLOMON'S PORCH

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891549523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOMON'S PORCH

Provider Business Mailing Address
First Line	:	2736 SENECA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-6666
Country	:	US
Telephone Number	:	864-706-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 SENECA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-6666
Country	:	US
Telephone Number	:	864-706-9757
Fax Number	:

Authorized Official
Title or Position	:	CARETAKER
Name	:	VITTORIO MORBETH
Credential	:
Telephone Number	:	864-706-9757

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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Directions to “SOLOMON'S PORCH ” Practice Location

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