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General NPI Number Information
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NPI Number | 1710547302
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Entity Type | Organization
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Legal Business Name | VICTORIAS RETIREMENT HOME ALF INC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 2233 NW 56TH AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313-3003
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Country | US
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Telephone | 786-262-7386
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 NW 56TH AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313-3003
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Country | US
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Telephone | 786-262-7386
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRENCE DANCYKIER
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Credential |
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Telephone | 786-262-7386
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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 |
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License Number State |
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