Organization
SHARING FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGEL L COX (ADMIN)
(772) 370-6765
Entity
Organization
Contact information
Practice address
2897 HARSON WAY, FORT PIERCE, FL 34946-6709
(772) 370-6765
(772) 464-2112
Mailing address
2897 HARSON WAY, FORT PIERCE, FL 34946-6709
(772) 370-6765
(772) 464-2112
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11722
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142150600
—
FL
05
—
679849796
—
FL
Enumeration date
10/09/2010
Last updated
10/09/2010
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