Provider Demographics
NPI:1386625036
Name:VILLA MARIA NURSING & REHABILITATION CENTER
Entity type:Organization
Organization Name:VILLA MARIA NURSING & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-891-8850
Mailing Address - Street 1:1050 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5805
Mailing Address - Country:US
Mailing Address - Phone:305-891-8850
Mailing Address - Fax:305-891-3361
Practice Address - Street 1:1050 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5805
Practice Address - Country:US
Practice Address - Phone:305-891-8850
Practice Address - Fax:305-891-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1576096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203165Medicaid
FL120022Medicaid
FL203165Medicaid
FL103026Medicare ID - Type Unspecified