Basic Information
| Provider Information | |||||||||
| NPI: | 1669776563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE VILLA ASSISTED LIVING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 429 NAPOLEON PL | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159012504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142544514 | ||||||||
| FaxNumber: | 8142544541 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 WARREN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142881418 | ||||||||
| FaxNumber: | 8142881525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2011 | ||||||||
| LastUpdateDate: | 01/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | KASTELIC | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8142544514 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 328361 | PA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.