Sa-PG -Port St Lucie LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1419096 Issued in FL

Legal business name

SA-PG -PORT ST LUCIE LLC

Doing business as

Palm Garden of Port St. Lucie

Practice address

1751 SE Hillmoor Dr
Port St Lucie, FL 34952-7535

Phone

(772) 335-8844

Fax

(772) 335-9954

NPI assigned

Jun 22, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Alex Paley

Title

Coo

Phone

(914) 390-4363

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palm Garden of Port St. Lucie Doing business as

Tax ID family

Palm Garden of Port St Lucie2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palm Garden of Port St Lucie LLC

  • Skilled Nursing Facility
  • Port St Lucie, FL
  • NPI 1770918724
  NPD tax ID

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1982600102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 SE HILLMOOR DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527535",
            "telephone_number": "772-335-8844",
            "fax_number": "772-335-9954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 SE HILLMOOR DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527535",
            "telephone_number": "772-335-8844",
            "fax_number": "772-335-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA-PG -PORT ST LUCIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "914-390-4363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1419096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025724900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Garden of Port St. Lucie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Port St Lucie, FL
• Providers in Port St 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 Jul 22, 2008; 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.