NPIMap

Organization Active NPI

Hospital Without Walls of Port St. Lucie, Inc

  • Home Health Agency
  • Port St Lucie, FL
National Provider Identifier
1306002365
Registry record updated Feb 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HOSPITAL WITHOUT WALLS OF PORT ST. LUCIE, INC
Practice address
201 SW Port St Lucie Blvd
Ste 106
Port St Lucie, FL 34984-5023
Phone
(772) 879-9700
Fax
(772) 879-9777
NPI assigned
Jul 30, 2008
Last updated
Feb 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2012

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

Authorized official

Name
Mr. Baher F Habib, RPTNPI 1992901359
Title
President
Phone
(561) 436-9595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

201 SW Port St Lucie Blvd
Ste 106
Port St Lucie, FL 34984-5023

Mailing address

201 SW Port St Lucie Blvd
Ste 106
Port St Lucie, FL 34984-5023
Phone (772) 879-9700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101104000268 FL Part A Provider - Home Health Agency 9537224985 Practice locations: Port St Lucie, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306002365. Details of each certification follow.

Home health agency certification: CCN 109662

Legal name
HOSPITAL WITHOUT WALLS OF PORT ST. LUCIE, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 5, 2010
Last certification
May 31, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Oct 5, 2004 in FL
Enrollment address
201 SW Port St Lucie Blvd
Suite 106
Port St Lucie, FL 34984-5001

Care Compare: Home health agency

Medicare Care Compare
Listed as
Hospital Without Walls of Port St Lucie, Inc.CCN 109662 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Jun 5, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1087000Hospital Without Walls of Port St Lucie Inc201 SW Port St Lucie Blvd Ste 106, Port Saint Lucie, FL 34984Certificate of waiverJul 23, 2028

National Provider Directory

National Provider Directory

Locations

201 SW Port St Lucie Blvd
Ste 106
Port St Lucie, FL 34984
Phone (772) 879-9700

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Baher Fouad Habib Individual 5% Or Greater Direct Ownership Interest Oct 15, 2004 50%
Corporate OfficerCeo Nov 22, 2016 50%
Corporate DirectorCeo Nov 22, 2016 50%
W-2 Managing EmployeeCeo Nov 22, 2016 50%
Operational/Managerial ControlCeo Nov 22, 2016 50%
Emad Rofail Ishak Individual 5% Or Greater Direct Ownership Interest Sep 22, 2010
General Partnership Interest Sep 22, 2010
Corporate Director Sep 22, 2010

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1217376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1306002365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SW PORT ST LUCIE BLVD",
            "address_2": "STE 106",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349845023",
            "telephone_number": "772-879-9700",
            "fax_number": "772-879-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SW PORT ST LUCIE BLVD",
            "address_2": "STE 106",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349845023",
            "telephone_number": "772-879-9700",
            "fax_number": "772-879-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL WITHOUT WALLS OF PORT ST. LUCIE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-30",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "HABIB",
        "authorized_official_first_name": "BAHER",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-436-9595",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.