Basic Information
| Provider Information | |||||||||
| NPI: | 1164786562 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAGE PLACE RETIREMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18400 COCHRAN BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339483343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417668900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18400 COCHRAN BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339483343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417668900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | FARINA | ||||||||
| AuthorizedOfficialFirstName: | TRACI | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9414971117 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TJM PROPERTY MANAGEMENT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL9249 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.