Provider Demographics
NPI:1770884801
Name:COUNCIL ON AGING OF ST. LUCIE INC.
Entity type:Organization
Organization Name:COUNCIL ON AGING OF ST. LUCIE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-336-8608
Mailing Address - Street 1:2501 SW BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984
Mailing Address - Country:US
Mailing Address - Phone:772-465-5220
Mailing Address - Fax:
Practice Address - Street 1:2501 SW BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984
Practice Address - Country:US
Practice Address - Phone:772-465-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 261QA0600X
FL5047376J00000X
FL353385H00000X
FL8644385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty