Provider Demographics
NPI:1073762431
Name:REMWAY PORT ST LUCIE, LLC
Entity Type:Organization
Organization Name:REMWAY PORT ST LUCIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARTINA
Authorized Official - Last Name:MAHABIR-HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-323-2661
Mailing Address - Street 1:525 NW LAKE WHITNEY PL
Mailing Address - Street 2:SUITE 102 BLDG P
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1605
Mailing Address - Country:US
Mailing Address - Phone:772-323-2661
Mailing Address - Fax:772-323-2666
Practice Address - Street 1:525 NW LAKE WHITNEY PL
Practice Address - Street 2:SUITE 102 BLDG P
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1605
Practice Address - Country:US
Practice Address - Phone:772-323-2661
Practice Address - Fax:772-323-2666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B.S.A.M. HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies