Organization
MARLEE'S GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVENA VIXAMAR RN (OWNER/ MANAGER)
(954) 600-9295
Entity
Organization
Contact information
Practice address
3861 SW ROSSER BLVD, PORT SAINT LUCIE, FL 34953-7084
(954) 600-9295
Mailing address
3861 SW ROSSER BLVD, PORT SAINT LUCIE, FL 34953-7084
(954) 600-9295
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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