Provider Demographics
NPI:1124385828
Name:GINNY'S PLACE OF VIERA
Entity Type:Organization
Organization Name:GINNY'S PLACE OF VIERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:AC
Authorized Official - Last Name:DURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-258-2351
Mailing Address - Street 1:685 ROSSMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1963
Mailing Address - Country:US
Mailing Address - Phone:321-258-2351
Mailing Address - Fax:
Practice Address - Street 1:1198 AUBURN LAKES DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6780
Practice Address - Country:US
Practice Address - Phone:321-258-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11161310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility