VICK STREET MANOR
NPI 1851695399
Assisted Living Facility in Port Charlotte, FL

Q: What is Family Extended Care Of Punta Gorda, Inc's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since December 24, 2010CLIA 10D2194113 · Waiver

22332 VICK ST, PORT CHARLOTTE, FL 33980(941) 627-5388(941) 627-2007 Get Directions Write a Review

NPPES record last updated: December 24, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Vick Street Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VICK STREET MANOR (NPI 1851695399) is a healthcare organization registered as an assisted living facility in Port Charlotte, Florida and active in the NPI registry since December 2010. The organization holds a CLIA Waiver certificate valid through September 27, 2026 and lists Debra M Lewis, Director Of Quality Assurance, as its authorized official.

NPPES Registry Identity

NPI1851695399

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameFAMILY EXTENDED CARE OF PUNTA GORDA, INC

Location Address22332 VICK STPort Charlotte, FL 33980-2053

Mailing Address22332 Vick StPort Charlotte, FL 33980-2053 · (941) 627-5388 · Fax (941) 627-2007

Phone(941) 627-5388

Fax(941) 627-2007

Organization SubpartNo

Authorized OfficialDebra M LewisDirector Of Quality Assurance · (239) 247-3248

Enumeration DateDecember 24, 2010

✔ NPI 1851695399 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in FL · AL5016

Definition

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.

22332 VICK ST, Port Charlotte, FL 33980

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Other Names 1

Doing Business AsVick Street Manor

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2194113

Family Extended Care Of Punta Gorda · Port Charlotte, FL

Active · expires Sep 27, 2026

CLIA Number10D2194113

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateSeptember 28, 2024

Certificate Expiration DateSeptember 27, 2026

Laboratory DirectorKatie L. Wadsworth

Laboratory Phone(941) 627-5388

Laboratory LocationFamily Extended Care Of Punta Gorda22332 Vick St, Port Charlotte, FL 33980

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BEST CARE SENIOR LIVING AT PORT CHARLOTTE LLC

Assisted Living Facility

22332 VICK ST
PORT CHARLOTTE, FL 33980

Charlotte County (941) 627-5388

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Family Extended Care Of Punta Gorda, Inc's NPI number?

The NPI number for Family Extended Care Of Punta Gorda, Inc is 1851695399. It was assigned to this organization in the NPPES registry on December 24, 2010. The provider is doing business as Vick Street Manor.

Where is Family Extended Care Of Punta Gorda, Inc located?

Family Extended Care Of Punta Gorda, Inc is located at 22332 Vick St, Port Charlotte, FL 33980. The listed phone number is (941) 627-5388.

What is Family Extended Care Of Punta Gorda, Inc's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Family Extended Care Of Punta Gorda, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2194113) is associated with this NPI, valid through September 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Family Extended Care Of Punta Gorda, Inc was last updated on December 24, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.