Provider Demographics
NPI:1619313442
Name:ST AUBYN SENIOR SERVICES INC
Entity type:Organization
Organization Name:ST AUBYN SENIOR SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-336-3457
Mailing Address - Street 1:4161 SW TUMBLE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3146
Mailing Address - Country:US
Mailing Address - Phone:772-336-3457
Mailing Address - Fax:772-336-5939
Practice Address - Street 1:4161 SW TUMBLE ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3146
Practice Address - Country:US
Practice Address - Phone:772-336-3457
Practice Address - Fax:772-336-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11124310400000X
FLAL10938310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility