Provider Demographics
NPI:1568845469
Name:VILLA ANNA ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:VILLA ANNA ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TASHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-319-0831
Mailing Address - Street 1:353 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8007
Mailing Address - Country:US
Mailing Address - Phone:727-239-0658
Mailing Address - Fax:727-239-0613
Practice Address - Street 1:353 COLONIAL CT
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8007
Practice Address - Country:US
Practice Address - Phone:727-239-0658
Practice Address - Fax:727-239-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12663310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility