=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982040325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE VILLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2013
-----------------------------------------------------
Last Update Date | 05/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4216 SW 5TH PL
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33914-5898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-540-7385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4216 SW 5TH PL
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33914-5898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SOLIENNE DARBOUZE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-839-8009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10148
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------