Organization
INDEPENDENT LIVING WITH CARE, INC. ALF
Active
Other names
ALF
Organization subpart
No
Provider details
NPI number
Authorized official
TISA FORTE (OWNER)
(772) 878-1010
Entity
Organization
Contact information
Practice address
3165 SW FAMBROUGH ST, PORT ST LUCIE, FL 34953-4541
(772) 878-1010
(772) 345-1402
Mailing address
3165 SW FAMBROUGH ST, PORT ST LUCIE, FL 34953-4541
(772) 878-1010
(772) 345-1402
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11368
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000179100
—
FL
05
—
000585500
—
FL
Enumeration date
07/17/2013
Last updated
07/17/2013
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