Organization
HEAVENLY ADULT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SONIA REID RN (ADMINISTRATOR)
(772) 626-9539
Entity
Organization
Contact information
Practice address
3934 SW KAKOPO ST, PORT ST LUCIE, FL 34953-3631
(772) 626-9539
Mailing address
3934 SW KAKOPO ST, PORT ST LUCIE, FL 34953-3631
(772) 626-9539
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
13020
FL
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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