Provider Demographics
NPI:1699886184
Name:HOSPICE OF MARTIN & ST LUCIE INC
Entity type:Organization
Organization Name:HOSPICE OF MARTIN & ST LUCIE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-403-4500
Mailing Address - Street 1:1201 SE INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-403-4500
Mailing Address - Fax:772-781-8723
Practice Address - Street 1:1201 SE INDIAN ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5688
Practice Address - Country:US
Practice Address - Phone:772-403-4500
Practice Address - Fax:772-781-8723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH AND PALLITIVE SERVICES OF THE TREASURE COAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50210961251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087514700Medicaid
FL101510Medicare PIN