Provider Demographics
NPI:1972126944
Name:VICTORIA'S RESIDENCE LLC
Entity type:Organization
Organization Name:VICTORIA'S RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PONCE AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-803-9318
Mailing Address - Street 1:16413 SW 81ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5717
Mailing Address - Country:US
Mailing Address - Phone:786-803-9318
Mailing Address - Fax:
Practice Address - Street 1:16413 SW 81ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5717
Practice Address - Country:US
Practice Address - Phone:786-803-9318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility