Provider Demographics
NPI:1760624365
Name:EGRET POND, LLC
Entity Type:Organization
Organization Name:EGRET POND, LLC
Other - Org Name:EGRET POND ADULT DAYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-288-1288
Mailing Address - Street 1:1760 SE SALERNO RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6442
Mailing Address - Country:US
Mailing Address - Phone:772-288-1288
Mailing Address - Fax:772-219-8458
Practice Address - Street 1:1760 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6442
Practice Address - Country:US
Practice Address - Phone:772-288-1288
Practice Address - Fax:772-219-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCE9977335311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home