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General NPI Number Information
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NPI Number | 1487042834
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Entity Type | Organization
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Legal Business Name | VIZCAYA ALF INC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 1621 N OCEAN BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3428
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Country | US
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Telephone | 954-782-6822
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Fax | 954-782-6826
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Provider Business Mailing Address
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Address Line | 1621 N OCEAN BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3428
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Country | US
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Telephone | 954-782-6822
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Fax | 954-782-6826
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. YURY LYUDIN
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Credential |
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Telephone | 215-432-3068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11555
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License Number State | FL
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