Provider Demographics
NPI:1316113343
Name:THE VILLA AT WILLOW COLONY LLC
Entity type:Organization
Organization Name:THE VILLA AT WILLOW COLONY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-883-9913
Mailing Address - Street 1:26110 WILLOW COLONY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6531
Mailing Address - Country:US
Mailing Address - Phone:281-395-0139
Mailing Address - Fax:281-395-6326
Practice Address - Street 1:26110 WILLOW COLONY LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6531
Practice Address - Country:US
Practice Address - Phone:281-395-0139
Practice Address - Fax:281-395-6326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHLINK GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1217363104A0630X, 343900000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care