Provider Demographics
NPI:1679558050
Name:VILLA ALBA CORPORATION
Entity type:Organization
Organization Name:VILLA ALBA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:VILLARAZA
Authorized Official - Last Name:TEJADA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:480-726-7773
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:480-726-7773
Mailing Address - Fax:480-726-7790
Practice Address - Street 1:1212 N. SPENCER ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
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:2005-12-08
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC3710251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031563Medicare Oscar/Certification