Provider Demographics
NPI:1417957309
Name:VILLA HEALTH CARE INC
Entity Type:Organization
Organization Name:VILLA HEALTH CARE INC
Other - Org Name:VILLA HEALTH CARE EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-744-3654
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-0109
Mailing Address - Country:US
Mailing Address - Phone:217-744-2299
Mailing Address - Fax:217-496-3165
Practice Address - Street 1:100 MARION PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-9673
Practice Address - Country:US
Practice Address - Phone:217-744-2299
Practice Address - Fax:217-496-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0037028314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid