Provider Demographics
NPI:1467718080
Name:VILLA SERENA V, INC
Entity Type:Organization
Organization Name:VILLA SERENA V, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-240-7131
Mailing Address - Street 1:2750 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4326
Mailing Address - Country:US
Mailing Address - Phone:305-206-5342
Mailing Address - Fax:305-668-0346
Practice Address - Street 1:2750 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4326
Practice Address - Country:US
Practice Address - Phone:305-206-5342
Practice Address - Fax:305-668-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11694310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003821100Medicaid