Family Extended Care of Punta Gorda, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL5016 Issued in FL

Legal business name

FAMILY EXTENDED CARE OF PUNTA GORDA, INC

Doing business as

Vick Street Manor

Practice address

22332 Vick St
Port Charlotte, FL 33980-2053

Phone

(941) 627-5388

Fax

(941) 627-2007

NPI assigned

Dec 24, 2010

Last updated

Dec 24, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debra M Lewis

Title

Director of Quality Assurance

Phone

(239) 247-3248

Specialties & licenses 1

Addresses

Other names 1

• Vick Street Manor Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1293148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293148800000",
    "number": "1851695399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22332 VICK ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802053",
            "telephone_number": "941-627-5388",
            "fax_number": "941-627-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22332 VICK ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802053",
            "telephone_number": "941-627-5388",
            "fax_number": "941-627-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY EXTENDED CARE OF PUNTA GORDA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-24",
        "last_updated": "2010-12-24",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF QUALITY ASSURANCE",
        "authorized_official_telephone_number": "239-247-3248"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL5016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vick Street Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Port Charlotte, FL
• Providers in Port Charlotte, 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 Dec 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.