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General NPI Number Information
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NPI Number | 1891070645
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Entity Type | Organization
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Legal Business Name | VILLA BELLE MOON ASSISTED LIVING INC
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 6305 TUCKERMAN LN
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City | ROCKVILLE
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State | MD
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Zip | 20852-3511
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Country | US
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Telephone | 240-463-7196
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Fax |
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Provider Business Mailing Address
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Address Line | 6305 TUCKERMAN LN
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City | ROCKVILLE
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State | MD
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Zip | 20852-3511
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Country | US
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Telephone | 240-463-7196
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Fax |
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Authorized Official
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Title or Position | ASSISTED LIVING MANAGER
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Name | MRS. MARIE MONA VIVENS
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Credential | R.N
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Telephone | 240-644-8399
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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 | 15AL0446-A
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License Number State | MD
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