Provider Demographics
NPI:1972505881
Name:VILLARAZA CORPORATION
Entity Type:Organization
Organization Name:VILLARAZA CORPORATION
Other - Org Name:DBA: VICTORY HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA LORANE
Authorized Official - Middle Name:TEJADA
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-726-6553
Mailing Address - Street 1:P.O. BOX 790
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-0790
Mailing Address - Country:US
Mailing Address - Phone:480-726-6553
Mailing Address - Fax:480-726-3329
Practice Address - Street 1:1212 N SPENCER
Practice Address - Street 2:SUITE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4347
Practice Address - Country:US
Practice Address - Phone:480-726-6553
Practice Address - Fax:480-726-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA 3549251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHHA 3549OtherSTATE LICENSE NUMBER
AZHHA 3549OtherSTATE LICENSE NUMBER