Provider Demographics
NPI:1235276551
Name:YARBOROUGH O'NEAL VILLA
Entity Type:Organization
Organization Name:YARBOROUGH O'NEAL VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIMISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-269-6061
Mailing Address - Street 1:551 PONY RD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-2572
Mailing Address - Country:US
Mailing Address - Phone:919-269-6061
Mailing Address - Fax:919-269-8806
Practice Address - Street 1:551 PONY RD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2572
Practice Address - Country:US
Practice Address - Phone:919-269-6061
Practice Address - Fax:919-269-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092-098310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility