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General NPI Number Information
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NPI Number | 1710138946
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Entity Type | Organization
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Legal Business Name | VICKEY'S HOME ALF
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 6402 SW 41 STREET
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 305-662-4845
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Fax | 855-631-3861
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Provider Business Mailing Address
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Address Line | 6402 SW 41 STREET
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 305-662-4845
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Fax | 855-631-3361
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Authorized Official
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Title or Position | OWNER
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Name | ANDY CAPOTE
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Credential |
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Telephone | 305-587-3125
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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 | AL11137
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License Number State | FL
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