Provider Demographics
NPI:1598876088
Name:HOSPICE OF THE TREASURE COAST INC
Entity Type:Organization
Organization Name:HOSPICE OF THE TREASURE COAST INC
Other - Org Name:TREASURE COAST HOSPICE ST. LUCIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-403-4500
Mailing Address - Street 1:1201 SE INDIAN STREET
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-403-4500
Mailing Address - Fax:772-781-8423
Practice Address - Street 1:5000-5090 DUNN ROAD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981
Practice Address - Country:US
Practice Address - Phone:772-462-8999
Practice Address - Fax:772-781-8723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH AND PALLATIVE SERVICES OF THE TREASURE COAST INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5033096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087528700Medicaid
FL087528700Medicaid