Provider Demographics
NPI:1528400066
Name:NATURE'S EDGE, INC.
Entity Type:Organization
Organization Name:NATURE'S EDGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-879-7530
Mailing Address - Street 1:699 NW AIROSO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1108
Mailing Address - Country:US
Mailing Address - Phone:772-879-7530
Mailing Address - Fax:772-879-7533
Practice Address - Street 1:699 NW AIROSO BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1108
Practice Address - Country:US
Practice Address - Phone:772-879-7530
Practice Address - Fax:772-879-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8849310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility