Provider Demographics
NPI:1821092321
Name:VILLA MARIA NURSING AND REHABILITATION COMMUNITY, INC.
Entity Type:Organization
Organization Name:VILLA MARIA NURSING AND REHABILITATION COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-564-3387
Mailing Address - Street 1:20 BABCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1226
Mailing Address - Country:US
Mailing Address - Phone:860-564-3387
Mailing Address - Fax:860-564-6651
Practice Address - Street 1:20 BABCOCK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1226
Practice Address - Country:US
Practice Address - Phone:860-564-3387
Practice Address - Fax:860-564-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1006-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075084Medicare ID - Type Unspecified
CT075084Medicare UPIN