NPIMap

Organization Active NPI

Bayshore Residence Alf

  • Adult Day Care Clinic/Center
  • Port Saint Lucie, FL
National Provider Identifier
1497922538
Registry record updated May 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
AL750 Issued in FL
Legal business name
BAYSHORE RESIDENCE ALF
Practice address
686 SW Lucero Dr
Port Saint Lucie, FL 34983-1894
Phone
(772) 871-1106
Fax
(772) 871-1104
NPI assigned
May 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2008

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

Authorized official

Name
Ms. Violet Verona Burke7728711106
Title
Administrator
Phone
(772) 871-1106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X AL750 FL Primary

Addresses

Primary practice location

686 SW Lucero Dr
Port Saint Lucie, FL 34983-1894

Mailing address

686 SW Lucero Dr
Port Saint Lucie, FL 34983-1894
Phone (772) 871-1106

Other names 1

  • Assisted Living Facility Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1497922538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "686 SW LUCERO DR",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349831894",
            "telephone_number": "772-871-1106",
            "fax_number": "772-871-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "686 SW LUCERO DR",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349831894",
            "telephone_number": "772-871-1106",
            "fax_number": "772-871-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE RESIDENCE ALF",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "BURKE7728711106",
        "authorized_official_first_name": "VIOLET",
        "authorized_official_middle_name": "VERONA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-871-1106",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "FL",
            "license": "AL750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Assisted Living Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; 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.