MEDICARE: VICTORIA GARDEN ALF, 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	3104A0625X	Assisted Living Facility (Mental Illness)	10631	FL

General Provider Information

NPI Number	:	1720431067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA GARDEN ALF, INC.

Provider Business Mailing Address
First Line	:	550 OCEAN BLVD
Second Line	:
City	:	GOLDEN BEACH
State	:	FL
Zip	:	33160-2216
Country	:	US
Telephone Number	:	786-547-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3091 NW 43RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4310
Country	:	US
Telephone Number	:	786-547-4222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SEGEY SANDLER
Credential	:
Telephone Number	:	718-207-3198

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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