Healthcare Provider Details

I. General information

NPI: 1366438657
Provider Name (Legal Business Name): VILLA MARIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S CENTRAL AVE
MULVANE KS
67110-1718
US

IV. Provider business mailing address

116 S CENTRAL AVE
MULVANE KS
67110-1718
US

V. Phone/Fax

Practice location:
  • Phone: 316-777-1129
  • Fax: 316-777-4406
Mailing address:
  • Phone: 316-777-1129
  • Fax: 316-777-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN096007
License Number StateKS

VIII. Authorized Official

Name: MS. REBECCA R MURRAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 316-777-1129