Provider Demographics
NPI:1881771095
Name:VILLACARE LLC
Entity type:Organization
Organization Name:VILLACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR BRYAN
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-880-6591
Mailing Address - Street 1:4898 DEEDER COURT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-4209
Mailing Address - Country:US
Mailing Address - Phone:904-880-6591
Mailing Address - Fax:904-880-6591
Practice Address - Street 1:4898 DEEDER COURT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-4209
Practice Address - Country:US
Practice Address - Phone:904-880-6591
Practice Address - Fax:904-880-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health