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General NPI Number Information
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NPI Number | 1578184867
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Entity Type | Organization
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Legal Business Name | VIVANT VENTURE I LLC
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 920 VERSAILLES CIR
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City | MAITLAND
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State | FL
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Zip | 32751-4567
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Country | US
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Telephone | 407-543-2028
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Fax |
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Provider Business Mailing Address
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Address Line | 478 E ALTAMONTE DR STE 108360
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4628
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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 | ADMINISTRATOR
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Name | MR. ERIC FIEDLER
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Credential |
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Telephone | 541-861-5000
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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 |
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License Number State |
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