Provider Demographics
NPI:1609235597
Name:VILLA'S ALF #2, INC.
Entity Type:Organization
Organization Name:VILLA'S ALF #2, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-270-9354
Mailing Address - Street 1:16116 TAMPA ST
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-6125
Mailing Address - Country:US
Mailing Address - Phone:813-519-2765
Mailing Address - Fax:813-570-7166
Practice Address - Street 1:16116 TAMPA ST
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6125
Practice Address - Country:US
Practice Address - Phone:813-519-2765
Practice Address - Fax:813-570-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11700310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016632800Medicaid