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General NPI Number Information
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NPI Number | 1821926767
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Entity Type | Organization
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Legal Business Name | VIV SERENITY HAVEN LLC
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 75111 NASSAU STATION WAY
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City | YULEE
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State | FL
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Zip | 32097-3862
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Country | US
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Telephone | 347-888-8623
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Fax |
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Provider Business Mailing Address
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Address Line | 192 SW INWOOD AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4917
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Country | US
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Telephone | 347-888-8623
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. VIVETTE MALCOLM
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Credential | RN
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Telephone | 347-888-8623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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