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General NPI Number Information
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NPI Number | 1568705473
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Entity Type | Organization
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Legal Business Name | VILLAVERDE INC
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 4470 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-6646
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Country | US
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Telephone | 321-383-2125
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Fax | 321-383-2125
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Provider Business Mailing Address
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Address Line | 4470 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-6646
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Country | US
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Telephone | 321-383-2125
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Fax | 321-383-2125
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Authorized Official
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Title or Position | OWNER / ADMINISTRATOR
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Name | MRS. JEAN ALCEDO VILLAVERDE
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Credential | RN, BSN
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Telephone | 407-257-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL7358
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License Number State | FL
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