Provider Demographics
NPI:1306002365
Name:HOSPITAL WITHOUT WALLS OF PORT ST. LUCIE, INC
Entity Type:Organization
Organization Name:HOSPITAL WITHOUT WALLS OF PORT ST. LUCIE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BAHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:561-436-9595
Mailing Address - Street 1:201 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5023
Mailing Address - Country:US
Mailing Address - Phone:772-879-9700
Mailing Address - Fax:772-879-9777
Practice Address - Street 1:201 SW PORT ST LUCIE BLVD
Practice Address - Street 2:STE 106
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5023
Practice Address - Country:US
Practice Address - Phone:772-879-9700
Practice Address - Fax:772-879-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health