Provider Demographics
NPI:1174615074
Name:VILLA MARIA ADULT DAY CARE
Entity type:Organization
Organization Name:VILLA MARIA ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PRIVACY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:954-739-6233
Mailing Address - Street 1:20855 NW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6801
Mailing Address - Country:US
Mailing Address - Phone:954-739-6233
Mailing Address - Fax:954-733-1532
Practice Address - Street 1:20855 NW 9TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6801
Practice Address - Country:US
Practice Address - Phone:954-739-6233
Practice Address - Fax:954-733-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility