Healthcare Provider Details

I. General information

NPI: 1912166091
Provider Name (Legal Business Name): VILLA MARIA NURSING & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 NW 122ND ST
HIALEAH GARDENS FL
33018-1748
US

IV. Provider business mailing address

4790 N STATE ROAD 7
LAUDERDALE LAKES FL
33319-5860
US

V. Phone/Fax

Practice location:
  • Phone: 305-731-5181
  • Fax:
Mailing address:
  • Phone: 954-484-1515
  • Fax: 954-484-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF130471041
License Number StateFL

VIII. Authorized Official

Name: MARY JO FRICK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 954-484-1515