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Organization
VITALITY STAR RESORT ALF LLC
Active
Organization
VITALITY STAR RESORT ALF LLC
Active
Other names
Vitality Star Resort
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTELLA DORVAL (ADMINISTRATOR)
(772) 207-7947
Entity
Organization
Contact information
Practice address
591 SW BRADSHAW CIR, PORT ST LUCIE, FL 34953-5539
(772) 207-7947
Mailing address
11380 SW HILLCREST CIR, PORT ST LUCIE, FL 34987-2704
(772) 539-0405
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023404800
—
FL
Enumeration date
10/16/2018
Last updated
10/16/2018
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