Provider Demographics
NPI:1083322275
Name:ST LUCIE WELLNESS AND REHAB,LLC
Entity Type:Organization
Organization Name:ST LUCIE WELLNESS AND REHAB,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DECOSTE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JEUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-460-4517
Mailing Address - Street 1:6981 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8207
Mailing Address - Country:US
Mailing Address - Phone:772-777-4869
Mailing Address - Fax:
Practice Address - Street 1:6981 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8207
Practice Address - Country:US
Practice Address - Phone:772-777-4869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center