Healthcare Provider Details

I. General information

NPI: 1518199090
Provider Name (Legal Business Name): VIERA RETIREMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 WATERSONG LN
VIERA FL
32940-2625
US

IV. Provider business mailing address

7300 WATERSONG LN
VIERA FL
32940-2625
US

V. Phone/Fax

Practice location:
  • Phone: 321-253-7450
  • Fax:
Mailing address:
  • Phone: 321-253-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11595
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL11595
License Number StateFL

VIII. Authorized Official

Name: MR. DONALD THOMPSON
Title or Position: MANAGER
Credential:
Phone: 704-246-1620