Provider Demographics
NPI:1063658086
Name:TREASURE COAST PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:TREASURE COAST PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-403-4500
Mailing Address - Street 1:1201 SE INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5688
Mailing Address - Country:US
Mailing Address - Phone:772-403-4500
Mailing Address - Fax:772-781-8031
Practice Address - Street 1:1201 SE INDIAN ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5688
Practice Address - Country:US
Practice Address - Phone:772-403-4500
Practice Address - Fax:772-781-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty