# VICTORIAN MANOR, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Victorian Manor, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972121192
- **Authorized official:** NOEMI RODRIGUEZ (ONWNER)
- **Authorized official phone:** (954) 236-4300

## Contact information

- **Practice address:** 11150 SW 42ND CT, DAVIE, FL 33328-2140
- **Practice address phone:** (954) 236-4300
- **Mailing address:** 15140 SW 38TH ST, DAVIE, FL 33331-2755
- **Mailing address phone:** (954) 816-3203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 07/14/2020
- **Last updated:** 07/14/2020