Provider Demographics
NPI:1124156815
Name:VILLA SANTA MARIA
Entity type:Organization
Organization Name:VILLA SANTA MARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGUILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-281-3609
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008
Mailing Address - Country:US
Mailing Address - Phone:505-281-3609
Mailing Address - Fax:505-281-0124
Practice Address - Street 1:19 CIRQUELA RD
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008
Practice Address - Country:US
Practice Address - Phone:505-281-3609
Practice Address - Fax:505-281-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1115322D00000X
NM1116322D00000X
NM1114322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children