Provider Demographics
NPI:1447241559
Name:FREDERICK VILLA INVESTMENTS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FREDERICK VILLA INVESTMENTS & ASSOCIATES, LLC
Other - Org Name:FREDERICK VILLA NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:711 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1802
Mailing Address - Country:US
Mailing Address - Phone:410-788-3300
Mailing Address - Fax:
Practice Address - Street 1:711 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1802
Practice Address - Country:US
Practice Address - Phone:410-788-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD783314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122627400Medicaid
MD215178Medicare Oscar/Certification