Victorian Manor Retirement Center,Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALF 12348 Issued in FL

Legal business name

VICTORIAN MANOR RETIREMENT CENTER,INC.

Practice address

4685 Chumuckla Highway
Pace, FL 32571

Phone

(850) 736-8412

NPI assigned

Apr 16, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Terry L. Stacey

Title

Administrator

Phone

(850) 736-8412

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1710320064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 CHUMUCKLA HIGHWAY",
            "city": "PACE",
            "state": "FL",
            "postal_code": "32571",
            "telephone_number": "850-736-8412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4685 CHUMUCKLA HIGHWAY",
            "city": "PACE",
            "state": "FL",
            "postal_code": "32571",
            "telephone_number": "850-736-8412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIAN MANOR RETIREMENT CENTER,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-16",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "STACEY",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-736-8412",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "ALF 12348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Tuttle, MD
• Angela Adams Ullon, P.A.
• Cheri M. Van Atta, L.M.T.
• Mong Linh Thi Van, OD
• Haley Marie Vaughn, PHARM D
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• Matthew Carl Walters, PHARMD

• Assisted Living Facility in Pace, FL
• Providers in Pace, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.