Provider Demographics
NPI:1164637708
Name:VILLA ROSE INC.
Entity Type:Organization
Organization Name:VILLA ROSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-682-9644
Mailing Address - Street 1:2120 SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3544
Mailing Address - Country:US
Mailing Address - Phone:805-682-9644
Mailing Address - Fax:805-682-5714
Practice Address - Street 1:2120 SANTA BARBARA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3544
Practice Address - Country:US
Practice Address - Phone:805-682-9644
Practice Address - Fax:805-682-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility