Provider Demographics
NPI:1023005766
Name:VILLA TERESA
Entity Type:Organization
Organization Name:VILLA TERESA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUBROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-652-5900
Mailing Address - Street 1:1051 AVILA RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5304
Mailing Address - Country:US
Mailing Address - Phone:717-652-5900
Mailing Address - Fax:717-652-5941
Practice Address - Street 1:1051 AVILA RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5304
Practice Address - Country:US
Practice Address - Phone:717-652-5900
Practice Address - Fax:717-652-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA480802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility