Provider Demographics
NPI:1780351718
Name:VILLA PALMS ASSISTED LIVING LLC
Entity type:Organization
Organization Name:VILLA PALMS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-213-2883
Mailing Address - Street 1:6722 WINKLER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7204
Mailing Address - Country:US
Mailing Address - Phone:239-433-5553
Mailing Address - Fax:239-481-9919
Practice Address - Street 1:6722 WINKLER RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7204
Practice Address - Country:US
Practice Address - Phone:239-433-5553
Practice Address - Fax:239-481-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7353OtherAHCA