Basic Information
| Provider Information | |||||||||
| NPI: | 1174615074 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLA MARIA ADULT DAY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20855 NW 9TH CT | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331696801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547396233 | ||||||||
| FaxNumber: | 9547331532 | ||||||||
| Practice Location | |||||||||
| Address1: | 20855 NW 9TH CT | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331696801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547396233 | ||||||||
| FaxNumber: | 9547331532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9547396233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RHIA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311Z00000X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility |
No ID Information.