Provider Demographics
NPI:1992388235
Name:TREASURE COAST COMMUNITY HEALTH INC
Entity Type:Organization
Organization Name:TREASURE COAST COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-257-8224
Mailing Address - Street 1:1555 INDIAN RIVER BLVD STE B210
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7113
Mailing Address - Country:US
Mailing Address - Phone:772-257-8224
Mailing Address - Fax:772-213-3157
Practice Address - Street 1:4675 28TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-1329
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-213-3157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREASURE COAST COMMUNITY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy