MEDICARE: FLORIDA DEPARTMENT OF VETERANS AFFAIRS

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	311500000X	Alzheimer Center (Dementia Center)	SNF130471019	FL
2	314000000X	Skilled Nursing Facility	SNF130471019	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417949579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF VETERANS AFFAIRS

Provider Business Mailing Address
First Line	:	8401 W CYPRESS DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4540
Country	:	US
Telephone Number	:	954-985-4824
Fax Number	:	954-985-4866

Provider Business Practice Location Address
First Line	:	8401 W CYPRESS DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4540
Country	:	US
Telephone Number	:	954-985-4824
Fax Number	:	954-985-4866

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. CLAUDIA R DAY
Credential	:
Telephone Number	:	727-518-3202

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/03/2008

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