Provider Demographics
NPI:1417482852
Name:VINCENT VICTORIA VILLAGE
Entity Type:Organization
Organization Name:VINCENT VICTORIA VILLAGE
Other - Org Name:HEALTHCORE SYSTEMS MANAGEMENT LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-247-8259
Mailing Address - Street 1:4607 E CALIFORNIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-7571
Mailing Address - Country:US
Mailing Address - Phone:817-247-8259
Mailing Address - Fax:817-536-0177
Practice Address - Street 1:4607 E CALIFORNIA PKWY
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-7571
Practice Address - Country:US
Practice Address - Phone:817-247-8259
Practice Address - Fax:817-536-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143865310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility