| NPI | 1851695399 |
|---|---|
| Doing Business As | VICK STREET MANOR |
| Entity Type | Organization |
| Authorized Contact | DEBRA M LEWIS Director Of Quality Assurance 239-247-3248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL5016) |
| Enumeration Date | 2010-12-24 |
| Last Update Date | 2010-12-24 |