Provider Demographics
NPI:1093125791
Name:ADULT ACTIVITY CENTER OF THE TREASURE COAST, INC
Entity Type:Organization
Organization Name:ADULT ACTIVITY CENTER OF THE TREASURE COAST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YENY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIERA REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-365-8367
Mailing Address - Street 1:579 NW LAKE WHITNEY PLACE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1622
Mailing Address - Country:US
Mailing Address - Phone:772-237-4500
Mailing Address - Fax:772-237-4412
Practice Address - Street 1:579 NW LAKE WHITNEY PLACE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1622
Practice Address - Country:US
Practice Address - Phone:772-237-4500
Practice Address - Fax:772-237-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9264251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based