COUNTRY LIVING ASSISTED CARE CENTER INC (NPI# 1417135682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417135682 |
| Entity Type | Organization |
| Organization Name | COUNTRY LIVING ASSISTED CARE CENTER INC |
| Practice Address |
1762 Sw Arch St Port Saint Lucie FL 34953-1558 |
| Practice Telephone | 7726218211 |
| Practice Fax Number | 7726218211 |
| Mailing Telephone | 7726218211 |
| Mailing Fax Number | 7726218211 |
| Enumeration Date | 2008-02-09 |
| Last Update Date | 2008-10-31 |
| Authorized Official Name | CAROL ANN CAMMARSANA (ADM) |
| Authorized Official Telephone | 7726261150 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL11331 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | MEDWAIVER | 692697596 | 01 |
| Street Address |
1762 SW ARCH ST |
| City | PORT SAINT LUCIE |
| State | FL |
| Zip Code | 34953-1558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733720 | Paul Desantis | Optometrist | 1805 Gatlin Blvd, Port St. Lucie, FL 34953 | 2020-05-29 |
| 1174165997 | D&r Homehealthcare LLC | Technician | 1210 Southwest Santiago Avenue, Port Saint Lucie, Fl, FL 34953 | 2019-10-14 |
| 1023677630 | Physical Therapy Wellness Group | Clinic/Center | 519 Sw Nagle Place, Port Saint Lucie, FL 34953 | 2019-06-07 |
| 1063993699 | Bloom Firm, LLC | Home Health | 1714 Sw Cycle St, Port Saint Lucie, FL 34953 | 2018-08-22 |
| 1386121333 | For His Glory Alf LLC. | Assisted Living Facility | 322 Sw South Quick Circle, Port St Lucie, FL 34953 | 2018-07-23 |
| 1730670555 | Susan May Thyme | Nurse Practitioner | 1762 Sw Choate St, Port Saint Lucie, FL 34953 | 2018-05-29 |
| 1164911301 | Viven Banks | Counselor | 3581 Sw Kromrey St, Port Saint Lucie, FL 34953 | 2018-05-03 |
| 1205323441 | Katherine Monroig | Behavior Technician | 4557 Se Babylon St, Port Saint Lucie, FL 34953 | 2018-04-13 |
| 1528567583 | Roger Rene Trudel | Nurse Practitioner | 3686 Sw Carmody Street, Port St Lucie, FL 34953 | 2018-02-06 |
| 1801315502 | Metushela Nicolas | Adult Companion | 1112 Jennifer Ter, Port Saint Lucie, FL 34953 | 2017-09-13 |
| Find all providers in zip 34953 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629697446 | Browns House Assisted Living Facility LLC | Assisted Living Facility | 2241 Se Melaleuca Blvd, Port Saint Lucie, FL 34952-6748 | 2020-04-12 |
| 1255998274 | Morningside Alf | Assisted Living Facility | 2233 Se Mroningside Alf, Port Saint Lucie, FL 34952 | 2019-05-24 |
| 1457814832 | Michael Noelus | Assisted Living Facility | 554 Nw Kilpatrick Ave, Port Saint Lucie, FL 34983-8719 | 2019-04-11 |
| 1881152882 | Zulia Brenovil | Assisted Living Facility | 578 Sw Violet Ave, Port Saint Lucie, FL 34983-8739 | 2019-03-08 |
| 1275091472 | Eugnie Mcpherson | Assisted Living Facility | 6260 Nw Topaz Way, Port Saint Lucie, FL 34986-3863 | 2019-03-06 |
| 1407343361 | St. Lucie Hope Gardens LLC | Assisted Living Facility | 337 Sw Grimaldo Teraace, Port Saint Lucie, FL 34984 | 2018-04-17 |
| 1083113070 | Fabulous Resort Assisted Living Facilitator LLC | Assisted Living Facility | 1762 Se Carvalho St, Port Saint Lucie, FL 34983-4554 | 2018-02-06 |
| 1700398799 | Live Love Laugh Assissted Living | Assisted Living Facility | 1766 Sw Columbia St, Port Saint Lucie, FL 34987-2073 | 2017-10-30 |
| 1356867592 | Oneil Mcewan | Assisted Living Facility | 4022 Sw Bamberg Street, Port Saint Lucie, FL 34953 | 2017-08-18 |
| 1962936591 | Unique Helping Hands Inc | Assisted Living Facility | 150 Sw Port St Lucie Blvd, Port Saint Lucie, FL 34984-5041 | 2017-04-20 |
| Find all providers in PORT SAINT LUCIE | ||||
| City | PORT SAINT LUCIE |
| Zip Code | 34953 |
Please comment or provide details below to improve the information on COUNTRY LIVING ASSISTED CARE CENTER INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.