Provider Demographics
NPI:1578760492
Name:VILLA PRISSY
Entity Type:Organization
Organization Name:VILLA PRISSY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-4976
Mailing Address - Street 1:5524SW 5STREET ST
Mailing Address - Street 2:
Mailing Address - City:MIAMIDADE
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-261-4976
Mailing Address - Fax:
Practice Address - Street 1:5524 SW 5STREET ST
Practice Address - Street 2:
Practice Address - City:MIAMIDADE
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-261-4976
Practice Address - Fax:305-260-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8549310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEMPLOYER IDENTIFICATION N