Provider Demographics
NPI:1992141659
Name:INTL ALF LLC DBA VENICE GREEN VILLAGE
Entity type:Organization
Organization Name:INTL ALF LLC DBA VENICE GREEN VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROGERIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURENZIO
Authorized Official - Suffix:
Authorized Official - Credentials:CFO, OWNER, HQA
Authorized Official - Phone:786-233-8368
Mailing Address - Street 1:2745 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2425
Mailing Address - Country:US
Mailing Address - Phone:941-488-5970
Mailing Address - Fax:941-485-4187
Practice Address - Street 1:2745 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-2425
Practice Address - Country:US
Practice Address - Phone:941-488-5970
Practice Address - Fax:941-485-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7804310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility