MEDICARE: FAMILY EXTENDED CARE OF VERO BEACH, 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

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811193329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EXTENDED CARE OF VERO BEACH, INC.

Provider Business Mailing Address
First Line	:	1934 22ND AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3084
Country	:	US
Telephone Number	:	772-794-1277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 22ND AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3084
Country	:	US
Telephone Number	:	772-794-1277
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	TIFFANY COLLINS
Credential	:
Telephone Number	:	407-761-8473

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	12/03/2019

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