Provider Demographics
NPI:1245755966
Name:VEDADEVI LLC
Entity Type:Organization
Organization Name:VEDADEVI LLC
Other - Org Name:VEDA ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MOHANDAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-427-9698
Mailing Address - Street 1:765 E PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2273
Mailing Address - Country:US
Mailing Address - Phone:1561-427-9698
Mailing Address - Fax:
Practice Address - Street 1:1538 SE FACULTY CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7603
Practice Address - Country:US
Practice Address - Phone:561-427-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness