Provider Demographics
NPI:1730135716
Name:FORT PIERCE HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:FORT PIERCE HEALTH CARE ASSOCIATES LLC
Other - Org Name:FORT PIERCE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:YERKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-464-5262
Mailing Address - Street 1:611 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4054
Mailing Address - Country:US
Mailing Address - Phone:772-464-5262
Mailing Address - Fax:772-464-5022
Practice Address - Street 1:611 S 13TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4054
Practice Address - Country:US
Practice Address - Phone:772-464-5262
Practice Address - Fax:772-464-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF10040953314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025223900Medicaid
105257Medicare Oscar/Certification