Provider Demographics
NPI:1649590977
Name:PACIFICA VICTORIA COURT LP
Entity Type:Organization
Organization Name:PACIFICA VICTORIA COURT LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DELMONICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-946-5522
Mailing Address - Street 1:55 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-9334
Mailing Address - Country:US
Mailing Address - Phone:401-946-5522
Mailing Address - Fax:401-942-5582
Practice Address - Street 1:55 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-9334
Practice Address - Country:US
Practice Address - Phone:401-946-5522
Practice Address - Fax:401-942-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care