Port St. Lucie MGT LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF14940961 Issued in FL

Legal business name

PORT ST. LUCIE MGT LLC

Doing business as

Emerald Health Care Center

Practice address

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

Phone

(772) 337-1333

Fax

(772) 337-9856

NPI assigned

Dec 2, 2005

Last updated

Oct 8, 2020By 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

Mr. Lavern Patrick Herzog

Title

President

Phone

(386) 668-9498

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Emerald Health Care Center Doing business as

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1548244502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 SE WALTON RD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527657",
            "telephone_number": "772-337-1333",
            "fax_number": "772-337-9856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 SE WALTON RD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527657",
            "telephone_number": "772-337-1333",
            "fax_number": "772-337-9856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ST. LUCIE MGT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "LAVERN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-668-9498",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF14940961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026163700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emerald Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emerald Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Michelle Pomerantz
• Jorge Ponce
• Sabrina Cathleen Pope, PTA, LMT,NCTM
• Port Saint Lucie Imaging LLC
• Port St Lucie Medical Wellness
• Winsome Powell
• Omar Poyo
• Silvia Esther Pozo
• Maria Defatima Pozuelo, MD
• Premier Physical Therapy & Sports Medicine

• Skilled Nursing Facility in Port Saint Lucie, FL
• Providers in Port Saint 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 Oct 8, 2020; 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.