Provider Demographics
NPI:1437395134
Name:ALWAYS RELIABLE MED WAIVER
Entity Type:Organization
Organization Name:ALWAYS RELIABLE MED WAIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. HILAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-626-6139
Mailing Address - Street 1:1258 SW EMPIRE ST.
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:772-905-8745
Mailing Address - Fax:772-905-8746
Practice Address - Street 1:1258 SW EMPIRE ST.
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-626-6139
Practice Address - Fax:772-905-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690231698Medicaid
FL690231696Medicaid