Organization
CROSSTOWN FAMILY CARE HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELLIE JOHNSON (DIRECTOR)
(954) 667-5616
Entity
Organization
Contact information
Practice address
1850 SW MACKENZIE ST, PORT ST LUCIE, FL 34953-1329
(954) 667-5616
(772) 333-2894
Mailing address
1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953-1329
(954) 667-5616
(772) 333-2894
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
311Z00000X
Custodial Care Facility
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
678513
—
FL
Enumeration date
09/01/2016
Last updated
09/25/2017
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