Provider Demographics
NPI:1114355278
Name:THE CORNERSTONES OF PORT ST. LUCIE, INC.
Entity Type:Organization
Organization Name:THE CORNERSTONES OF PORT ST. LUCIE, INC.
Other - Org Name:ROSIE'S PLACE ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-879-4950
Mailing Address - Street 1:1102 SW IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2542
Mailing Address - Country:US
Mailing Address - Phone:772-879-4950
Mailing Address - Fax:772-807-7544
Practice Address - Street 1:1102 SW IVANHOE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2542
Practice Address - Country:US
Practice Address - Phone:772-879-4950
Practice Address - Fax:772-807-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11602310400000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140258700Medicaid
FL11967589OtherAHCA NUMBER (FILE NUMBER)
FL11602OtherLICENSE NUMBER