A Bethel Loving Care of the Treasure Coast

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

A BETHEL LOVING CARE OF THE TREASURE COAST

Practice address

1816 SW Brisbane St
Port St Lucie, FL 34984-3507

Phone

(772) 353-5535

Fax

(772) 673-0885

NPI assigned

Sep 14, 2021

Last updated

Sep 14, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charmaine Jackson Wallen

Title

Administrator

Phone

(772) 353-5535

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1083384838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6136 SUGAR LOAF LN",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334116414",
            "telephone_number": "561-667-0050",
            "fax_number": "772-673-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 SW BRISBANE ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843507",
            "telephone_number": "772-353-5535",
            "fax_number": "772-673-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BETHEL LOVING CARE OF THE TREASURE COAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON WALLEN",
        "authorized_official_first_name": "CHARMAINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-353-5535"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "13156",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "abethel.lovingcare@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1816 SW Brisbane St",
            "city": "Port St Lucie",
            "state": "FL",
            "country_code": "US",
            "postal_code": "349843507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.