Provider Demographics
NPI:1194204917
Name:VILLA CREST LLC
Entity Type:Organization
Organization Name:VILLA CREST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-288-1418
Mailing Address - Street 1:1451 FRANKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-1318
Mailing Address - Country:US
Mailing Address - Phone:814-288-1418
Mailing Address - Fax:814-288-1525
Practice Address - Street 1:1451 FRANKSTOWN RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15902-1318
Practice Address - Country:US
Practice Address - Phone:814-288-1418
Practice Address - Fax:814-288-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility