NPIMap

Organization Active NPI

Crosstown Family Care Home, Inc

  • Custodial Care Facility
  • Port St Lucie, FL
National Provider Identifier
1851848436
Registry record updated Sep 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Custodial Care FacilityTaxonomy code 311Z00000X
Legal business name
CROSSTOWN FAMILY CARE HOME, INC
Practice address
1850 SW Mackenzie St
Port St Lucie, FL 34953-1329
Phone
(954) 667-5616
Fax
(772) 333-2894
NPI assigned
Sep 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2017

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

Authorized official

Name
Nellie Johnson
Title
Director
Phone
(954) 667-5616

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Adult Day Care Clinic/Center 261QA0600X
Custodial Care Facility 311Z00000X Primary
Adult Care Home Facility 311ZA0620X
Mental Illness Community Based Residential Treatment Facility 320800000X
Private Vehicle 347C00000X

Addresses

Primary practice location

1850 SW Mackenzie St
Port St Lucie, FL 34953-1329

Mailing address

1850 Southwest Mackenzie Street
Port St Lucie, FL 34953-1329
Phone (954) 667-5616

Other identifiers 1

IdentifierTypeStateIssuer
678513MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506297600000",
    "number": "1851848436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 SOUTHWEST MACKENZIE STREET",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349531329",
            "telephone_number": "954-667-5616",
            "fax_number": "772-333-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SW MACKENZIE ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349531329",
            "telephone_number": "954-667-5616",
            "fax_number": "772-333-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSTOWN FAMILY CARE HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2017-09-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "NELLIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-667-5616"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "678513",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; 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.