Healthcare Provider Details

I. General information

NPI: 1497836274
Provider Name (Legal Business Name): VILLA ST JOHN VIANNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WOODBINE ROAD
DOWNINGTOWN PA
19335
US

IV. Provider business mailing address

151 WOODBINE ROAD
DOWNINGTOWN PA
19335
US

V. Phone/Fax

Practice location:
  • Phone: 610-269-2600
  • Fax: 610-873-8028
Mailing address:
  • Phone: 610-269-2600
  • Fax: 610-873-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number124630
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number023898
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL CZEKNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-368-0900