Healthcare Provider Details

I. General information

NPI: 1447241559
Provider Name (Legal Business Name): FREDERICK VILLA INVESTMENTS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ACADEMY RD
CATONSVILLE MD
21228-1802
US

IV. Provider business mailing address

711 ACADEMY RD
CATONSVILLE MD
21228-1802
US

V. Phone/Fax

Practice location:
  • Phone: 410-788-3300
  • Fax:
Mailing address:
  • Phone: 410-788-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number783
License Number StateMD

VIII. Authorized Official

Name: MR. JOHN P. O'BRIEN JR.
Title or Position: CHIEF MANAGER
Credential:
Phone: 423-308-1845