Provider Demographics
NPI:1730134909
Name:MARBRIDGE VILLA
Entity Type:Organization
Organization Name:MARBRIDGE VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:P. DUNCAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-282-1811
Mailing Address - Street 1:2504 BLISS SPILLAR RD
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652
Mailing Address - Country:US
Mailing Address - Phone:512-282-1811
Mailing Address - Fax:
Practice Address - Street 1:2504 BLISS SPILLAR RD
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652
Practice Address - Country:US
Practice Address - Phone:512-282-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251J00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022766201Medicaid