Provider Demographics
NPI:1356726616
Name:LOVING CARE OF THE TREASURE COAST
Entity type:Organization
Organization Name:LOVING CARE OF THE TREASURE COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-240-9850
Mailing Address - Street 1:2102 SW LARCHMONT LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4321
Mailing Address - Country:US
Mailing Address - Phone:772-207-7136
Mailing Address - Fax:772-207-7148
Practice Address - Street 1:2102 SW LARCHMONT LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4321
Practice Address - Country:US
Practice Address - Phone:772-207-7136
Practice Address - Fax:772-207-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12683253Z00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12683Medicaid