MEDICARE: VILLA SERENA V, INC

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	AL11694	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	:	1467718080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA SERENA V, INC

Provider Business Mailing Address
First Line	:	2750 NW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4326
Country	:	US
Telephone Number	:	305-206-5342
Fax Number	:	305-668-0346

Provider Business Practice Location Address
First Line	:	2750 NW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4326
Country	:	US
Telephone Number	:	305-206-5342
Fax Number	:	305-668-0346

Authorized Official
Title or Position	:	OWNER
Name	:	ROXANA SOLANO
Credential	:
Telephone Number	:	305-240-7131

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	04/21/2020

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