Organization · NPI-2

1st Light Of Hope

Clinic/Center, Developmental Disabilities · Port Saint Lucie, FL

NPI number1497349625
StatusActive
Last updated in NPPESFeb 28, 2021

Details

NPI
1497349625
Entity type
Organization (NPI-2)
Legal business name
1st Light Of Hope
Organization subpart
No
Enumeration date
Feb 28, 2021
Certification date
Feb 28, 2021
Last updated
Feb 28, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD1600X Clinic/Center, Developmental Disabilities––Yes

Other names

  • None (Other Name)

Practice location

118 Sw Andover Ct
Port Saint Lucie, FL 34953-6961

Phone 772-214-5860 · Fax 800-854-2598

Mailing address

4451 Sw Darlington St
Port Saint Lucie, FL 34953-7607

Phone 772-214-5860 · Fax 800-854-2598

Authorized official

Don Durante Andrews
Owner
7722145860

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