1972505881 NPI number — VILLARAZA CORPORATION

Table of content: (NPI 1972505881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972505881 NPI number — VILLARAZA CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLARAZA CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA: VICTORY HOME CARE AGENCY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972505881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85211-0790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-726-6553
Provider Business Mailing Address Fax Number:
480-726-3329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N SPENCER
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85203-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-726-6553
Provider Business Practice Location Address Fax Number:
480-726-3329
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
EVA LORANE
Authorized Official Middle Name:
TEJADA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
480-726-6553

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA 3549 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HHA 3549 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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