Provider Demographics
NPI:1790935096
Name:VILLA MARIA LIVING SOLUTIONS,CORP
Entity Type:Organization
Organization Name:VILLA MARIA LIVING SOLUTIONS,CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-776-3983
Mailing Address - Street 1:790 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4126
Mailing Address - Country:US
Mailing Address - Phone:305-863-0156
Mailing Address - Fax:305-863-0156
Practice Address - Street 1:790 E 18TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-4126
Practice Address - Country:US
Practice Address - Phone:305-863-0156
Practice Address - Fax:305-863-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9187310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000157900Medicaid