Provider Demographics
NPI:1164786562
Name:VILLAGE PLACE RETIREMENT
Entity Type:Organization
Organization Name:VILLAGE PLACE RETIREMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-497-1117
Mailing Address - Street 1:18400 COCHRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-3343
Mailing Address - Country:US
Mailing Address - Phone:941-766-8900
Mailing Address - Fax:
Practice Address - Street 1:18400 COCHRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-3343
Practice Address - Country:US
Practice Address - Phone:941-766-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TJM PROPERTY MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9249310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility