Provider Demographics
NPI:1568705473
Name:VILLAVERDE INC
Entity Type:Organization
Organization Name:VILLAVERDE INC
Other - Org Name:RIVERVIEW RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ALCEDO
Authorized Official - Last Name:VILLAVERDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:407-257-2070
Mailing Address - Street 1:4470 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6646
Mailing Address - Country:US
Mailing Address - Phone:321-383-2125
Mailing Address - Fax:321-383-2125
Practice Address - Street 1:4470 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6646
Practice Address - Country:US
Practice Address - Phone:321-383-2125
Practice Address - Fax:321-383-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL73583104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness