Organization
MARA VILLA CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R TREBERT (CEO)
(817) 359-2000
Entity
Organization
Contact information
Practice address
8825 S 7TH ST, PHOENIX, AZ 85042-7626
(602) 243-6121
(602) 276-7390
Mailing address
PO BOX 155635, STE 400, FORT WORTH, TX 76155-0635
(817) 359-2000
(817) 359-2093
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI2644
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
882250
—
AZ
Enumeration date
08/22/2005
Last updated
08/22/2020
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