Provider Demographics
NPI:1144598913
Name:THE GIFT HOUSE, INC
Entity Type:Organization
Organization Name:THE GIFT HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:AYUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-249-0177
Mailing Address - Street 1:259 NE AIROSO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-249-0177
Mailing Address - Fax:
Practice Address - Street 1:259 NE AIROSO BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1675
Practice Address - Country:US
Practice Address - Phone:772-249-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility