Organization
GOOD SAMARITAN RETIREMENT HOME
Active
Other names
Viceda, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LORNA VICEDA (OWNER / ADMINISTRATOR)
(904) 521-7482
Entity
Organization
Contact information
Practice address
507 SE 1ST AVE, WILLISTON, FL 32696-2703
(904) 521-7482
Mailing address
507 SE 1ST AVE, WILLISTON, FL 32696-2703
(904) 521-7482
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
25
FL
Other
Enumeration date
07/31/2012
Last updated
07/31/2012
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