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General NPI Number Information
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NPI Number | 1023005766
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Entity Type | Organization
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Legal Business Name | VILLA TERESA
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1051 AVILA RD
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City | HARRISBURG
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State | PA
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Zip | 17109-5304
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Country | US
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Telephone | 717-652-5900
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Fax | 717-652-5941
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Provider Business Mailing Address
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Address Line | 1051 AVILA RD
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City | HARRISBURG
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State | PA
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Zip | 17109-5304
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Country | US
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Telephone | 717-652-5900
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Fax | 717-652-5941
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JANICE E DUBROSKY
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Credential |
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Telephone | 717-652-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 480802
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License Number State | PA
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