Provider Demographics
NPI:1689742785
Name:OUR LADY OF FATIMA VILLA
Entity Type:Organization
Organization Name:OUR LADY OF FATIMA VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-741-2950
Mailing Address - Street 1:20400 SARATOGA LOS GATOS ROAD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-0000
Mailing Address - Country:US
Mailing Address - Phone:408-741-2950
Mailing Address - Fax:408-741-4930
Practice Address - Street 1:20400 SARATOGA LOS GATOS ROAD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070
Practice Address - Country:US
Practice Address - Phone:408-741-2950
Practice Address - Fax:408-741-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000417310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05435FMedicaid
CAZZR05435FMedicaid