Organization
JADE RESIDENCE GROUP HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MABLE WALLACE (DIRECTOR)
(772) 873-8866
Entity
Organization
Contact information
Practice address
6790 NW MONOCO CT, PORT SAINT LUCIE, FL 34983-5342
(772) 873-8866
(772) 873-8866
Mailing address
6790 NW MONOCO CT, PORT SAINT LUCIE, FL 34983-5342
(772) 873-8866
(772) 873-8866
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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