Healthcare Provider Details

I. General information

NPI: 1770560856
Provider Name (Legal Business Name): VILLAGE VILLA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E WALNUT ST
NORTONVILLE KS
66060-4008
US

IV. Provider business mailing address

PO BOX 346
NORTONVILLE KS
66060-0346
US

V. Phone/Fax

Practice location:
  • Phone: 913-886-6400
  • Fax: 913-886-8695
Mailing address:
  • Phone: 913-886-6400
  • Fax: 913-886-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN044003
License Number StateKS

VIII. Authorized Official

Name: TRACY L BARTLEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 785-273-3383