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NPI Code Detail

MEDICARE: VILLA MARIA CARE CENTER, LLC

MEDICARE: VILLA MARIA CARE 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
1310400000XAssisted Living FacilityALC4564AZ
2314000000XSkilled Nursing FacilityNCI263AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902953813
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLA MARIA CARE CENTER, LLC
Provider Business Mailing Address
First Line : 4310 E GRANT RD
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2607
Country : US
Telephone Number : 520-323-9351
Fax Number :
Provider Business Practice Location Address
First Line : 4310 E GRANT RD
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2607
Country : US
Telephone Number : 602-368-8203
Fax Number : 602-368-8211
Authorized Official
Title or Position : OWNER
Name : TERRY MCNELLIS
Credential :
Telephone Number : 612-991-9062
Provider Enumeration Date : 01/04/2007
Last Update Date : 09/08/2021

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4310 E GRANT RD STE A
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85712-2607
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Directions to “VILLA MARIA CARE CENTER, LLC ” Practice Location

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