Provider Demographics
NPI:1801134846
Name:THE VILLAGE ALF I CORP.
Entity type:Organization
Organization Name:THE VILLAGE ALF I CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENIER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-986-9698
Mailing Address - Street 1:301 KAMAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-2745
Mailing Address - Country:US
Mailing Address - Phone:239-242-7449
Mailing Address - Fax:239-673-9207
Practice Address - Street 1:301 KAMAL PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-2745
Practice Address - Country:US
Practice Address - Phone:239-242-7449
Practice Address - Fax:239-673-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12313310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility