Provider Demographics
NPI:1083784011
Name:BROADMOOR ALZHEIMER'S & MEMORY IMPAIRMENT CENTER OF ST LUCIE COUNTY, I
Entity Type:Organization
Organization Name:BROADMOOR ALZHEIMER'S & MEMORY IMPAIRMENT CENTER OF ST LUCIE COUNTY, I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-489-6800
Mailing Address - Street 1:1550 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4972
Mailing Address - Country:US
Mailing Address - Phone:772-489-6800
Mailing Address - Fax:
Practice Address - Street 1:200 DIXIELAND DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6706
Practice Address - Country:US
Practice Address - Phone:772-489-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness