FAMILY EXTENDED CARE OF PUNTA GORDA, INC (NPI# 1851695399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851695399 |
| Entity Type | Organization |
| Organization Name | FAMILY EXTENDED CARE OF PUNTA GORDA, INC |
| Other Organization Name | VICK STREET MANOR |
| Practice Address |
22332 Vick St Port Charlotte FL 33980-2053 |
| Practice Telephone | 9416275388 |
| Practice Fax Number | 9416272007 |
| Mailing Telephone | 9416275388 |
| Mailing Fax Number | 9416272007 |
| Enumeration Date | 2010-12-24 |
| Last Update Date | 2010-12-24 |
| Authorized Official Name | DEBRA M LEWIS (DIRECTOR OF QUALITY ASSURANCE) |
| Authorized Official Telephone | 2392473248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL5016 | FL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Vick Street Manor | Doing Business As Name - Organization |
| Street Address |
22332 VICK ST |
| City | PORT CHARLOTTE |
| State | FL |
| Zip Code | 33980-2053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144699646 | Raymond B Hendricks | Custodial Care Facility | 1306 Annette St, Port Charlotte, FL 33980 | 2015-09-15 |
| 1649616517 | Anne Yvonne Clarke | Nurse's Aide | 3378 Idlewild Street, Port Charlotte, FL 33980 | 2013-05-17 |
| 1427395680 | John F Guarino Md Pa | Surgery | 4245 Kings Hwy, Unit A, Port Charlotte, FL 33980 | 2013-01-08 |
| 1497049027 | Patricia Ann Drow | Occupational Therapist | 24469 Manchester Trail, Port Charlotte, FL 33980 | 2011-05-31 |
| 1811221484 | Amanda K Huffman | Clinical Nurse Specialist | 22655 Bayshore Rd Ste 130, Port Charlotte, FL 33980 | 2009-09-29 |
| 1093967739 | Donna Olson | Nurse Practitioner | 1100 Loveland Boulevard, Port Charlotte, FL 33980 | 2008-10-14 |
| 1821278029 | Paula Marie Allison | Dietitian, Registered | 23422 Burlingame Ave, Port Charlotte, FL 33980 | 2007-11-06 |
| 1689865891 | Keith Anthony Williams | Physical Medicine & Rehabilitation | 4265 Laura Street, Port Charlotte, FL 33980 | 2007-08-05 |
| 1578685491 | Richard Michael Cocchieri | Dentist | Florida Department of Health In Charlotte County, 1100 Loveland Boulevard, Port Charlotte, FL 33980 | 2007-04-03 |
| 1417989328 | John F Guarino | Surgery | 4245 Kings Highway, Unit A, Port Charlotte, FL 33980 | 2006-07-07 |
| Find all providers in zip 33980 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891331427 | Bubbsh LLC | Assisted Living Facility | 370 Blarney St, Port Charlotte, FL 33954-3751 | 2019-11-19 |
| 1619318219 | Nic 4 Royal Palm Leasing LLC | Assisted Living Facility | 2500 Aaron St., Port Charlotte, FL 33952 | 2013-07-11 |
| 1811331283 | Nic 4 Village Place Leasing LLC | Assisted Living Facility | 18400 Cochran Blvd., Port Charlotte, FL 33948 | 2013-04-29 |
| 1841533122 | Royal Palm Retirement, LLC | Assisted Living Facility | 2500 Aaron St, Port Charlotte, FL 33952-6743 | 2013-04-04 |
| 1194090803 | Family Home Care II, Inc. | Assisted Living Facility | 1222 Zinnea St, Port Charlotte, FL 33952-1538 | 2012-03-13 |
| 1164791497 | Caring Hearts Alf | Assisted Living Facility | 21000 Midway Blvd, Port Charlotte, FL 33952-2451 | 2011-12-15 |
| 1861775603 | Snh Se Tenant Trs, Inc | Assisted Living Facility | 20480 Veterans Blvd, Port Charlotte, FL 33954-2264 | 2011-09-27 |
| 1245532621 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 18440 Cochran Blvd, Port Charlotte, FL 33948-3339 | 2010-11-17 |
| 1245436773 | Port Charolette Alf, LLC | Assisted Living Facility | 18400 Cochran Blvd, Port Charlotte, FL 33948-3343 | 2007-06-22 |
| 1487282349 | Mg Port Charlotte I Subtenant LLC | Assisted Living Facility | 2500 Aaron St, Port Charlotte, FL 33952-6743 | 2020-03-27 |
| Find all providers in PORT CHARLOTTE | ||||
| City | PORT CHARLOTTE |
| Zip Code | 33980 |
Please comment or provide details below to improve the information on FAMILY EXTENDED CARE OF PUNTA GORDA, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.