Healthcare Provider Details

I. General information

NPI: 1134366917
Provider Name (Legal Business Name): VILLAGE OAKS AT CONWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 E MICHIGAN ST
ORLANDO FL
32822-2779
US

IV. Provider business mailing address

5501 E MICHIGAN ST
ORLANDO FL
32822-2779
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-7225
  • Fax: 407-277-6690
Mailing address:
  • Phone: 407-277-7225
  • Fax: 407-277-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9286
License Number StateFL

VIII. Authorized Official

Name: MRS. CHRISTINA L. CIOTTA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-277-7225