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NPI Code Detail

MEDICARE: VILLA FATIMA ORO VALLEY LLC

MEDICARE: VILLA FATIMA ORO VALLEY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityAZ

General Provider Information

NPI Number : 1205185634
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLA FATIMA ORO VALLEY LLC
Provider Business Mailing Address
First Line : 1119 E RANCHO VISTOSO BLVD
Second Line :
City : ORO VALLEY
State : AZ
Zip : 85755-9106
Country : US
Telephone Number : 520-903-4099
Fax Number : 520-844-1060
Provider Business Practice Location Address
First Line : 1119 E RANCHO VISTOSO BLVD
Second Line :
City : ORO VALLEY
State : AZ
Zip : 85755-9106
Country : US
Telephone Number : 520-903-4099
Fax Number : 520-844-1060
Authorized Official
Title or Position : MANAGER
Name : MR. KELLY COPELAND
Credential :
Telephone Number : 520-903-4099
Provider Enumeration Date : 08/30/2012
Last Update Date : 08/30/2012

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Directions to “VILLA FATIMA ORO VALLEY LLC ” Practice Location

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