Organization
SHANEDAS TIME TO CARE LLC
Active
Other names
Shaneada vancol
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANEADA VANCOL I (OWNER)
(772) 501-6619
Entity
Organization
Contact information
Practice address
6233 NW GISELA ST, PORT SAINT LUCIE, FL 34986-3866
(772) 777-9827
Mailing address
1881 SW ELIJAH AVE, PORT SAINT LUCIE, FL 34953-3495
(772) 501-6619
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
FL
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022855600
—
FL
Enumeration date
10/31/2017
Last updated
07/12/2024
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