Provider Demographics
NPI:1023489044
Name:MEADOW CARE ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:MEADOW CARE ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILMOT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:561-707-0133
Mailing Address - Street 1:686 SW LUCERO DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1894
Mailing Address - Country:US
Mailing Address - Phone:772-237-5253
Mailing Address - Fax:
Practice Address - Street 1:686 SW LUCERO DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1894
Practice Address - Country:US
Practice Address - Phone:772-237-5253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12739310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility