Healthcare Provider Details

I. General information

NPI: 1447249149
Provider Name (Legal Business Name): VICTORIA NURSING & REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 NW 3RD ST
MIAMI FL
33128-1274
US

IV. Provider business mailing address

955 NW 3RD ST
MIAMI FL
33128-1274
US

V. Phone/Fax

Practice location:
  • Phone: 305-548-4020
  • Fax: 305-777-2000
Mailing address:
  • Phone: 305-548-4020
  • Fax: 305-548-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF130471016
License Number StateFL

VIII. Authorized Official

Name: RICHARD STACEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-548-4020