Provider Demographics
NPI:1083100440
Name:LOVING CARE OF THE TREASURE COAST II, LLC
Entity Type:Organization
Organization Name:LOVING CARE OF THE TREASURE COAST II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-240-9850
Mailing Address - Street 1:1816 SW BRISBANE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3507
Mailing Address - Country:US
Mailing Address - Phone:772-353-5263
Mailing Address - Fax:772-353-5263
Practice Address - Street 1:1816 SW BRISBANE ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3507
Practice Address - Country:US
Practice Address - Phone:772-353-5263
Practice Address - Fax:772-353-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13156310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility