Provider Demographics
NPI:1346739406
Name:VILLA ROSA NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:VILLA ROSA NURSING AND REHABILITATION CENTER LLC
Other - Org Name:VILLA ROSA AND REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF AR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-275-9799
Mailing Address - Street 1:3800 LOTTSFORD VISTA RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4018
Mailing Address - Country:US
Mailing Address - Phone:443-275-9799
Mailing Address - Fax:
Practice Address - Street 1:3800 LOTTSFORD VISTA RD
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-4018
Practice Address - Country:US
Practice Address - Phone:443-275-9799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD750503500Medicaid