MEDICARE: THE VILLA TREATMENT CENTER, 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
1	324500000X	Substance Abuse Rehabilitation Facility	190807AP	CA

General Provider Information

NPI Number	:	1366846214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLA TREATMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	5051 HOOD DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-4713
Country	:	US
Telephone Number	:	747-226-0187
Fax Number	:

Provider Business Practice Location Address
First Line	:	5051 HOOD DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-4713
Country	:	US
Telephone Number	:	747-226-0187
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	GEORGIA JEAN FRABOTTA
Credential	:
Telephone Number	:	818-571-8946

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	10/20/2014

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