MEDICARE: MADELEINE VILLA INC.

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
1	314000000X	Skilled Nursing Facility	505	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212762001	OTHER	WA	GROUP HEALTH COOPERATIVE
2	220	OTHER	WA	PREMERA BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MA4479	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1326030826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADELEINE VILLA INC.

Provider Business Mailing Address
First Line	:	5921 47TH AVE NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-5152
Country	:	US
Telephone Number	:	360-659-1259
Fax Number	:	360-657-3562

Provider Business Practice Location Address
First Line	:	5925 47TH AVE NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-5152
Country	:	US
Telephone Number	:	360-659-1259
Fax Number	:	360-657-3562

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. MICHAEL E. DOWNEY
Credential	:
Telephone Number	:	360-659-1259

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	08/26/2013

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Directions to “MADELEINE VILLA INC. ” Practice Location

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