Provider Demographics
NPI:1376884437
Name:MONICA L. VICKERS ASSOCIATES
Entity Type:Organization
Organization Name:MONICA L. VICKERS ASSOCIATES
Other - Org Name:MONICA L. VICKERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-206-6439
Mailing Address - Street 1:2313 MAMMOTH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-8583
Mailing Address - Country:US
Mailing Address - Phone:863-206-6439
Mailing Address - Fax:
Practice Address - Street 1:2313 MAMMOTH GROVE RD
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-8583
Practice Address - Country:US
Practice Address - Phone:863-206-6439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906570311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home