Organization
BAYSHORE RESIDENCE ALF
Active
Other names
Assisted Living Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIOLET VERONA BURKE7728711106 (ADMINISTRATOR)
(772) 871-1106
Entity
Organization
Contact information
Practice address
686 SW LUCERO DR, PORT SAINT LUCIE, FL 34983-1894
(772) 871-1106
(772) 871-1104
Mailing address
686 SW LUCERO DR, PORT SAINT LUCIE, FL 34983-1894
(772) 871-1106
(772) 871-1104
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
AL750
FL
Other
Enumeration date
05/08/2008
Last updated
05/08/2008
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