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General NPI Number Information
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NPI Number | 1780351718
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Entity Type | Organization
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Legal Business Name | VILLA PALMS ASSISTED LIVING LLC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 6722 WINKLER RD
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City | FORT MYERS
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State | FL
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Zip | 33919-7204
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Country | US
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Telephone | 239-433-5553
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Fax | 239-481-9919
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Provider Business Mailing Address
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Address Line | 6722 WINKLER RD
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City | FORT MYERS
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State | FL
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Zip | 33919-7204
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Country | US
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Telephone | 239-433-5553
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Fax | 239-481-9919
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Authorized Official
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Title or Position | OWNER
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Name | AJAY BAJAJ
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Credential |
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Telephone | 732-213-2883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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