Organization
VITALITY STAR RESORT ALF LLC
Active
Other names
Vitality Star Resort
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTELLA DORVAL (ADMINISTRATOR)
(772) 207-7947
Entity
Organization
Contact information
Practice address
591 SW BRADSHAW CIR, PORT ST LUCIE, FL 34953-5539
(772) 207-7947
Mailing address
11380 SW HILLCREST CIR, PORT ST LUCIE, FL 34987-2704
(772) 539-0405
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023404800
—
FL
Enumeration date
10/16/2018
Last updated
10/16/2018
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