Provider Demographics
NPI:1801567300
Name:VILLA MARIA CARE CENTER, LLC
Entity type:Organization
Organization Name:VILLA MARIA CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-991-9062
Mailing Address - Street 1:4310 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2607
Mailing Address - Country:US
Mailing Address - Phone:520-323-9351
Mailing Address - Fax:520-323-4087
Practice Address - Street 1:4310 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2607
Practice Address - Country:US
Practice Address - Phone:520-323-9351
Practice Address - Fax:520-323-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility