Provider Demographics
NPI:1356640098
Name:THE RETREAT AT ABINGDON
Entity Type:Organization
Organization Name:THE RETREAT AT ABINGDON
Other - Org Name:ABINGDON AT TRADITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTHCARE ADMINISTRATI
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-345-2700
Mailing Address - Street 1:10685 SW STONY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2741
Mailing Address - Country:US
Mailing Address - Phone:772-345-2700
Mailing Address - Fax:772-345-2701
Practice Address - Street 1:10685 SW STONY CREEK WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2741
Practice Address - Country:US
Practice Address - Phone:772-345-2700
Practice Address - Fax:772-345-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11967815310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility