Provider Demographics
NPI:1487026969
Name:DELRAY BEACH VILLA, LLC
Entity Type:Organization
Organization Name:DELRAY BEACH VILLA, LLC
Other - Org Name:GRAND VILLA OF DELRAY BEACH EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-726-3310
Mailing Address - Street 1:2210 34TH WAY STE C
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3909
Mailing Address - Country:US
Mailing Address - Phone:727-726-3310
Mailing Address - Fax:
Practice Address - Street 1:14555 SIMS RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8547
Practice Address - Country:US
Practice Address - Phone:561-496-1111
Practice Address - Fax:561-637-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5113310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility