Provider Demographics
NPI:1487042834
Name:VIZCAYA ALF INC
Entity Type:Organization
Organization Name:VIZCAYA ALF INC
Other - Org Name:VIZCAYA BY THE SEA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-432-3068
Mailing Address - Street 1:1621 N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3428
Mailing Address - Country:US
Mailing Address - Phone:954-782-6822
Mailing Address - Fax:954-782-6826
Practice Address - Street 1:1621 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3428
Practice Address - Country:US
Practice Address - Phone:954-782-6822
Practice Address - Fax:954-782-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11555310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility