Provider Demographics
NPI:1518443068
Name:TREASURE CARE ASSISTED FACILITY, LLC
Entity Type:Organization
Organization Name:TREASURE CARE ASSISTED FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONTHIA
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:561-460-9295
Mailing Address - Street 1:7504 CEDAR HURST CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7842
Mailing Address - Country:US
Mailing Address - Phone:561-460-9295
Mailing Address - Fax:
Practice Address - Street 1:5841 NW 56TH PL
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2326
Practice Address - Country:US
Practice Address - Phone:561-460-9295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10720310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility