Provider Demographics
NPI:1326030826
Name:MADELEINE VILLA INC.
Entity Type:Organization
Organization Name:MADELEINE VILLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-659-1259
Mailing Address - Street 1:5921 47TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5152
Mailing Address - Country:US
Mailing Address - Phone:360-659-1259
Mailing Address - Fax:360-657-3562
Practice Address - Street 1:5925 47TH AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5152
Practice Address - Country:US
Practice Address - Phone:360-659-1259
Practice Address - Fax:360-657-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA505314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA212762001OtherGROUP HEALTH COOPERATIVE
WA220OtherPREMERA BLUE CROSS
WA4150504Medicaid
WAMA4479OtherREGENCE BLUE SHIELD
WA220OtherPREMERA BLUE CROSS