Provider Demographics
NPI:1578207510
Name:ESSENTIAL CARE CENTER LLC
Entity Type:Organization
Organization Name:ESSENTIAL CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DORCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-330-8101
Mailing Address - Street 1:237 SW GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3017
Mailing Address - Country:US
Mailing Address - Phone:772-241-4569
Mailing Address - Fax:
Practice Address - Street 1:237 SW GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3017
Practice Address - Country:US
Practice Address - Phone:177-224-1456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services