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General NPI Number Information
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NPI Number | 1023641560
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Entity Type | Organization
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Legal Business Name | VIP KIDZ DEERFIELD LLC
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 2301 W SAMPLE RD BLDG 4
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City | POMPANO BEACH
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State | FL
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Zip | 33073-3081
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Country | US
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Telephone | 786-486-9513
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 W SAMPLE RD BLDG 4
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City | POMPANO BEACH
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State | FL
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Zip | 33073-3081
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA MANTILLA
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Credential |
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Telephone | 786-486-9513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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