Provider Demographics
NPI:1518084540
Name:VILLA CAMILLUS INC
Entity Type:Organization
Organization Name:VILLA CAMILLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIRHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-236-5091
Mailing Address - Street 1:10515 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-9575
Mailing Address - Country:US
Mailing Address - Phone:440-236-5091
Mailing Address - Fax:440-236-8909
Practice Address - Street 1:10515 E RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-9575
Practice Address - Country:US
Practice Address - Phone:440-236-5091
Practice Address - Fax:440-236-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1755N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164049Medicaid
OH0164049Medicaid