Port St Lucie Nursing LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PORT ST LUCIE NURSING LLC

Practice address

1655 SE Walton Rd
Port St Lucie, FL 34952-7657

Phone

(772) 337-1333

Fax

(772) 337-6485

NPI assigned

Jun 10, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Victoria Sharpless

Title

Director of Accounting

Phone

(352) 874-6007

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• THE PALMS NURSING AND REHAB AT PORT ST. LUCIE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623283200000",
    "number": "1043887631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 W LAKE MARY BLVD",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463417",
            "telephone_number": "352-874-6007",
            "fax_number": "352-404-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 SE WALTON RD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527657",
            "telephone_number": "772-337-1333",
            "fax_number": "772-337-6485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ST LUCIE NURSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "SHARPLESS",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "352-874-6007"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261637-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE PALMS NURSING AND REHAB AT PORT ST. LUCIE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Marie Polutchko, PA-C
• Ashley Polynice, LMHC
• Yvan Pompilus
• John Louis Porcaro, M.D.
• Port St Lucie Anesthesia LLC
• Port St Lucie Operating Corp
• Port St Lucie Pain Management PLLC
• Port St Lucie Pain Management Specialists Inc
• Port St Lucie Retirement Investors LLC
• Port St Lucie Surgery Center LTD

• Skilled Nursing Facility in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.