Provider Demographics
NPI:1013577600
Name:VICTORIA GARDENS HOME ALF INC
Entity Type:Organization
Organization Name:VICTORIA GARDENS HOME ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCYKIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-262-7386
Mailing Address - Street 1:3091 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4310
Mailing Address - Country:US
Mailing Address - Phone:786-262-7386
Mailing Address - Fax:
Practice Address - Street 1:3091 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4310
Practice Address - Country:US
Practice Address - Phone:786-262-7386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness