SPACE COAST ASSISTED LIVING LLC (NPI# 1629343470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629343470 |
| Entity Type | Organization |
| Organization Name | SPACE COAST ASSISTED LIVING LLC |
| Other Organization Name | HAMMOCK POINTE MANOR |
| Practice Address |
3366 Peninsula Cir Melbourne FL 32940-1107 |
| Mailing Address |
9060 S Tropical Trl Merritt Island FL 32952-6803 |
| Practice Telephone | 3216108323 |
| Mailing Telephone | 3216934269 |
| Mailing Fax Number | 3214060298 |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |
| Authorized Official Name | JOHNNIE MESAROS (PRESIDENT) |
| Authorized Official Telephone | 3216934269 |
| Authorized Official Credential | R.PH. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 11611 | FL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Hammock Pointe Manor | Doing Business As Name - Organization |
| Street Address |
3366 PENINSULA CIR |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32940-1107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215270194 | Hammock Manor Inc. | Assisted Living Facility | 3366 Peninsula Cir, Melbourne, FL 32940-1107 | 2013-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403649 | True Motion Physical Therapy and Wellness | Clinic/Center | 3536 Peninsula Circle, Mlebourne, FL 32940 | 2020-06-26 |
| 1568089431 | Live Gracefully Physio and Wellness, Pllc | Clinic/Center | 6470 Shadow Creek Trail, Apt 5204, Melbourne, FL 32940 | 2020-06-26 |
| 1295360592 | Hiteshi Patel | Pharmacist | 3134 Hummingbird Way, Melbourne, FL 32940 | 2020-03-06 |
| 1972133122 | Curtis Lynn Curbo | Social Worker | 3830 Fringetree Lane, Melbourne, FL 32940 | 2020-01-16 |
| 1861038283 | Medfast Urgent Care Centers, LLC | Clinic/Center | 5500 Stadium Parkway, Melbourne, FL 32940 | 2019-11-20 |
| 1134601594 | Caroline Grace Bennett | Behavior Technician | 5500 Murrell Rd Suite 100, Melbourne, FL 32940 | 2018-09-02 |
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1356849251 | Executive Non-emergency Transportation, Inc. | Non-emergency Medical Transport (VAN) | 3155-02 Suntree Blvd, Melbourne, FL 32940 | 2018-01-25 |
| 1679081160 | Brevard Oaks Center, LLC | Skilled Nursing Facility | 2355 Vidina Drive, Viera, FL 32940 | 2018-01-18 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| Find all providers in zip 32940 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922512656 | Chakiah Tucker Mitchell | Assisted Living Facility | 2421 Lipscomb St, Melbourne, FL 32901-5572 | 2017-11-16 |
| 1619329422 | Assisted Lovely Living Facility LLC | Assisted Living Facility | 1702 Trimble Rd, Melbourne, FL 32934-9034 | 2016-07-05 |
| 1770948853 | Allcia LLC | Assisted Living Facility | 4457 Parkway Dr, Melbourne, FL 32934-7767 | 2015-12-16 |
| 1760885784 | House of Light Senior Living IIi | Assisted Living Facility | 2306 Woodlawn Cir, Melbourne, FL 32934-7645 | 2014-10-04 |
| 1891100996 | Enclave Assisted Living II | Assisted Living Facility | 2518 Bernice Ct, Melbourne, FL 32935-3415 | 2014-06-26 |
| 1386072858 | Ginnys Place II | Assisted Living Facility | 2251 Turtle Mound Rd, Melbourne, FL 32934-7650 | 2013-10-21 |
| 1194153676 | Ginnys Place of Suntree | Assisted Living Facility | 730 Whispering Pines Cir, Melbourne, FL 32940-7831 | 2013-10-21 |
| 1457787962 | Grammys House Corp | Assisted Living Facility | 3401 Lakewood Dr, Melbourne, FL 32904-5206 | 2013-09-17 |
| 1043644495 | Florida Assisted Living Homes LLC | Assisted Living Facility | 2204 Parsons Ave, Melbourne, FL 32901-5234 | 2013-08-21 |
| 1831535616 | Guyco Senior Living Concepts | Assisted Living Facility | 2400 New York St, Melbourne, FL 32904-6230 | 2013-05-20 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.