Provider Demographics
NPI:1427428218
Name:SALIEN ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:SALIEN ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-919-5121
Mailing Address - Street 1:6817 NW GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1306
Mailing Address - Country:US
Mailing Address - Phone:772-919-5121
Mailing Address - Fax:
Practice Address - Street 1:6817 NW GRANGER AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1306
Practice Address - Country:US
Practice Address - Phone:772-919-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906759310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility