Provider Demographics
NPI:1033696232
Name:NEW DIMENSION FAMILY CARE INC.
Entity Type:Organization
Organization Name:NEW DIMENSION FAMILY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DWAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-709-4866
Mailing Address - Street 1:849 SW HAMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5629
Mailing Address - Country:US
Mailing Address - Phone:772-359-2874
Mailing Address - Fax:
Practice Address - Street 1:849 SW HAMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5629
Practice Address - Country:US
Practice Address - Phone:772-359-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13170310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL13170OtherAHCA
FL023957000Medicaid