1023606563 NPI number — THE VILLAGE SOUTH, INC

Table of content: (NPI 1023606563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023606563 NPI number — THE VILLAGE SOUTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VILLAGE SOUTH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023606563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-385-2090
Provider Business Mailing Address Fax Number:
702-924-2575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 BLUE LAGOON DR STE 445
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-696-0738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BLANCO
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
305-696-0738

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060590502 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com