Space Coast Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

11611 Issued in FL

Legal business name

SPACE COAST ASSISTED LIVING LLC

Doing business as

Hammock Pointe Manor

Practice address

3366 Peninsula Cir
Melbourne, FL 32940-1107

Phone

(321) 610-8323

NPI assigned

Mar 13, 2012

Last updated

Mar 13, 2012By 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

Johnnie Mesaros, R.PH.

Title

President

Phone

(321) 693-4269

Specialties & licenses 1

Addresses

Other names 1

• Hammock Pointe Manor Doing business as

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1629343470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9060 S TROPICAL TRL",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329526803",
            "telephone_number": "321-693-4269",
            "fax_number": "321-406-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 PENINSULA CIR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329401107",
            "telephone_number": "321-610-8323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "MESAROS",
        "authorized_official_first_name": "JOHNNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-693-4269",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "11611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hammock Pointe Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.