Organization
PORT ST. LUCIE MGT LLC
Active
Other names
Emerald Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVERN PATRICK HERZOG (PRESIDENT)
(386) 668-9498
Entity
Organization
Contact information
Practice address
1655 SE WALTON RD, PORT SAINT LUCIE, FL 34952-7657
(772) 337-1333
(772) 337-9856
Mailing address
1655 SE WALTON RD, PORT SAINT LUCIE, FL 34952-7657
(772) 337-1333
(772) 337-9856
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF14940961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026163700
—
FL
Enumeration date
12/02/2005
Last updated
10/08/2020
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