MEDICARE: VIERA RETIREMENT, 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	311500000X	Alzheimer Center (Dementia Center)	AL11595	FL
2	310400000X	Assisted Living Facility	AL11595	FL

General Provider Information

NPI Number	:	1518199090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIERA RETIREMENT, LLC

Provider Business Mailing Address
First Line	:	7300 WATERSONG LN
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-2625
Country	:	US
Telephone Number	:	321-253-7450
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 WATERSONG LN
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-2625
Country	:	US
Telephone Number	:	321-253-7450
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DONALD THOMPSON
Credential	:
Telephone Number	:	704-246-1620

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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