Independent Living With Care, Inc. Alf

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

11368 Issued in FL

Legal business name

INDEPENDENT LIVING WITH CARE, INC. ALF

Practice address

3165 SW Fambrough St
Port St Lucie, FL 34953-4541

Phone

(772) 878-1010

Fax

(772) 345-1402

NPI assigned

Jul 17, 2013

Organization subpart

No

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

Authorized official

Name

Tisa Forte

Title

Owner

Phone

(772) 878-1010

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ALF Former legal business name

Locations

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1679914741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 SW FAMBROUGH ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349534541",
            "telephone_number": "772-878-1010",
            "fax_number": "772-345-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 SW FAMBROUGH ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349534541",
            "telephone_number": "772-878-1010",
            "fax_number": "772-345-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT LIVING WITH CARE, INC. ALF",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "FORTE",
        "authorized_official_first_name": "TISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-878-1010"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "11368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000585500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000179100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALF",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Assisted Living Facility in Port St Lucie, FL
• Providers in Port St Lucie, 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 Jul 17, 2013; 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.