Healthcare Provider Details

I. General information

NPI: 1386625036
Provider Name (Legal Business Name): VILLA MARIA NURSING & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NE 125TH ST
NORTH MIAMI FL
33161-5805
US

IV. Provider business mailing address

1050 NE 125TH ST
NORTH MIAMI FL
33161-5805
US

V. Phone/Fax

Practice location:
  • Phone: 305-891-8850
  • Fax: 305-891-3361
Mailing address:
  • Phone: 305-891-8850
  • Fax: 305-891-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1576096
License Number StateFL

VIII. Authorized Official

Name: MR. NATHANIEL JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 305-891-8850