Organization
NEW DIMENSION FAMILY CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAINE HIBBERT (OWNER/ADMINISTRATOR)
(954) 709-4866
Entity
Organization
Contact information
Practice address
849 SW HAMBERLAND AVE, PORT ST LUCIE, FL 34953-5629
(772) 359-2874
Mailing address
849 SW HAMBERLAND AVE, PORT ST LUCIE, FL 34953-5629
(772) 359-2874
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL13170
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023957000
—
FL
01
—
AL13170
AHCA
FL
Enumeration date
07/20/2018
Last updated
07/20/2018
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