Provider Demographics
NPI:1154071769
Name:TREASURE COAST ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:TREASURE COAST ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACAUD BREZAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-563-2381
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34991-6587
Mailing Address - Country:US
Mailing Address - Phone:561-563-2381
Mailing Address - Fax:772-320-9396
Practice Address - Street 1:1914 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3489
Practice Address - Country:US
Practice Address - Phone:561-563-2381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness