Provider Demographics
NPI:1649674011
Name:SALUS ENTERPRISE LLC
Entity type:Organization
Organization Name:SALUS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAMIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARDO-AIKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-370-8107
Mailing Address - Street 1:457 SW BRIDGEPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953
Mailing Address - Country:US
Mailing Address - Phone:772-370-8107
Mailing Address - Fax:
Practice Address - Street 1:457 SW BRIDGEPORT DRIVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:772-370-8107
Practice Address - Fax:772-237-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care