Healthcare Provider Details

I. General information

NPI: 1518084540
Provider Name (Legal Business Name): VILLA CAMILLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 E RIVER RD
COLUMBIA STATION OH
44028-9575
US

IV. Provider business mailing address

10515 E RIVER RD
COLUMBIA STATION OH
44028-9575
US

V. Phone/Fax

Practice location:
  • Phone: 440-236-5091
  • Fax: 440-236-8909
Mailing address:
  • Phone: 440-236-5091
  • Fax: 440-236-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1755N
License Number StateOH

VIII. Authorized Official

Name: MR. BRUCE SCHIRHART
Title or Position: OWNER
Credential:
Phone: 440-236-5091