Organization
A BETHEL LOVING CARE OF THE TREASURE COAST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARMAINE JACKSON WALLEN (ADMINISTRATOR)
(772) 353-5535
Entity
Organization
Contact information
Practice address
1816 SW BRISBANE ST, PORT ST LUCIE, FL 34984-3507
(772) 353-5535
(772) 673-0885
Mailing address
6136 SUGAR LOAF LN, WEST PALM BEACH, FL 33411-6414
(561) 667-0050
(772) 673-0885
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13156
LICENSE NUMBER
FL
Enumeration date
09/14/2021
Last updated
09/14/2021
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