MEDICARE: VILLA MARGO III

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	AL9043	FL

General Provider Information

NPI Number	:	1538370507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA MARGO III

Provider Business Mailing Address
First Line	:	3669 SW 24TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3040
Country	:	US
Telephone Number	:	305-858-1840
Fax Number	:	305-225-1289

Provider Business Practice Location Address
First Line	:	3669 SW 24TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3040
Country	:	US
Telephone Number	:	305-858-1840
Fax Number	:	305-225-1289

Authorized Official
Title or Position	:	OWNER
Name	:	DOLORES FELICIA CRESPO
Credential	:
Telephone Number	:	305-858-1840

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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