Organization
COUNTRY LIVING ASSISTED CARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL ANN CAMMARSANA (ADM)
(772) 626-1150
Entity
Organization
Contact information
Practice address
1762 SW ARCH ST, PORT SAINT LUCIE, FL 34953-1558
(772) 621-8211
(772) 621-8211
Mailing address
1762 SW ARCH ST, PORT SAINT LUCIE, FL 34953-1558
(772) 621-8211
(772) 621-8211
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11331
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
692697596
MEDWAIVER
FL
Enumeration date
02/09/2008
Last updated
10/31/2008
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