MEDICARE: THE VICTORIAN CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1013490366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VICTORIAN CENTER, LLC

Provider Business Mailing Address
First Line	:	11 WHITEWIND LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5233
Country	:	US
Telephone Number	:	702-459-2567
Fax Number	:	702-982-6096

Provider Business Practice Location Address
First Line	:	11 WHITEWIND LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5233
Country	:	US
Telephone Number	:	702-459-2567
Fax Number	:	702-982-6096

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARIA FE ANTONIO
Credential	:
Telephone Number	:	702-459-2567

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	09/12/2018

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Directions to “THE VICTORIAN CENTER, LLC ” Practice Location

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