Space Coast Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SPACE COAST ASSISTED LIVING LLC

Practice address

1832 Country Club Dr
Titusville, FL 32780-5346

Phone

(321) 567-4191

Fax

(888) 335-7714

NPI assigned

Oct 18, 2021

Organization subpart

No

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

Authorized official

Name

Marie M Auguste

Title

Owner

Phone

(561) 503-3719

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1629731591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 COUNTRY CLUB DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805346",
            "telephone_number": "321-567-4191",
            "fax_number": "888-335-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 COUNTRY CLUB DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805346",
            "telephone_number": "321-567-4191",
            "fax_number": "888-335-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "AUGUSTE",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-503-3719"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "10800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Sorbello, DO
• Renee Lok-Yee Wong Soucier, MD
• South Titusville Medical Center Inc
• Southern Living of Titusville
• Sovereign Healthcare of Titusville, LLC
• Space Coast Health Centers Inc
• Space Coast Medical Associates LLP
• Space Coast Medical Center
• Space Coast Medical Consultants PLLC
• Space Coast Ophthalmology LLC

• Assisted Living Facility in Titusville, FL
• Providers in Titusville, 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 Oct 18, 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.