Provider Demographics
NPI:1750459186
Name:M. VILLARD INC
Entity Type:Organization
Organization Name:M. VILLARD INC
Other - Org Name:PALMETTO GUEST HOME,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORELIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-722-2789
Mailing Address - Street 1:820 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5018
Mailing Address - Country:US
Mailing Address - Phone:941-722-2789
Mailing Address - Fax:941-722-8423
Practice Address - Street 1:820 5TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5018
Practice Address - Country:US
Practice Address - Phone:941-722-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility