Healthcare Provider Details

I. General information

NPI: 1851842611
Provider Name (Legal Business Name): PEACE VILLA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RAILROAD DR
NORWOOD YOUNG AMERICA MN
55368-2601
US

IV. Provider business mailing address

600 RAILROAD DR
NORWOOD YOUNG AMERICA MN
55368-2601
US

V. Phone/Fax

Practice location:
  • Phone: 952-467-3692
  • Fax: 952-467-3156
Mailing address:
  • Phone: 952-467-3692
  • Fax: 952-467-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number378632
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number378221
License Number StateMN

VIII. Authorized Official

Name: LAURIE HILGERS
Title or Position: HOUSING DIRECTOR
Credential:
Phone: 952-467-9683