Provider Demographics
NPI:1366438657
Name:VILLA MARIA, INC.
Entity type:Organization
Organization Name:VILLA MARIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-777-1129
Mailing Address - Street 1:116 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1718
Mailing Address - Country:US
Mailing Address - Phone:316-777-1129
Mailing Address - Fax:316-777-4406
Practice Address - Street 1:116 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1718
Practice Address - Country:US
Practice Address - Phone:316-777-1129
Practice Address - Fax:316-777-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN096007314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100109490AMedicaid
KSN096007OtherSTATE LICENSE NUMBER
KS100109490AMedicaid