Provider Demographics
NPI:1114097839
Name:STUART OPERATING CORP
Entity Type:Organization
Organization Name:STUART OPERATING CORP
Other - Org Name:STUART NURSING & RESTORATIVE CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FICOCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-464-5911
Mailing Address - Street 1:7300 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8221
Mailing Address - Country:US
Mailing Address - Phone:772-464-5911
Mailing Address - Fax:
Practice Address - Street 1:1500 SE PALM BEACH RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4044
Practice Address - Country:US
Practice Address - Phone:772-283-5887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL203998314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022599100Medicaid
FL022599100Medicaid