Provider Demographics
NPI:1720749856
Name:VILLA HOLISTIC CAREGIVERS, LLC
Entity Type:Organization
Organization Name:VILLA HOLISTIC CAREGIVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MWENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULENGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-657-3647
Mailing Address - Street 1:4001 W DEVON AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4539
Mailing Address - Country:US
Mailing Address - Phone:773-657-3647
Mailing Address - Fax:
Practice Address - Street 1:4001 W DEVON AVE STE 412
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4539
Practice Address - Country:US
Practice Address - Phone:773-657-3647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care