Provider Demographics
NPI:1154601003
Name:VILLA HOME CARE LLC
Entity type:Organization
Organization Name:VILLA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-644-3331
Mailing Address - Street 1:1220 VILLA COURT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:MN
Mailing Address - Zip Code:55726
Mailing Address - Country:US
Mailing Address - Phone:218-644-3331
Mailing Address - Fax:218-644-3505
Practice Address - Street 1:1220 VILLA COURT DR
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:MN
Practice Address - Zip Code:55726-4503
Practice Address - Country:US
Practice Address - Phone:218-644-3331
Practice Address - Fax:218-644-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN352691251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN352691OtherMINNESOTA DEPARTMENT OF HEALTH CLASS A HOME CARE LICENSE