Healthcare Provider Details

I. General information

NPI: 1376656512
Provider Name (Legal Business Name): PIERZ VILLA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 FAUST ST
PIERZ MN
56364-9540
US

IV. Provider business mailing address

119 FAUST ST PO BOX 397
PIERZ MN
56364-9540
US

V. Phone/Fax

Practice location:
  • Phone: 320-468-6405
  • Fax: 320-468-0088
Mailing address:
  • Phone: 320-468-6405
  • Fax: 320-468-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331139
License Number StateMN

VIII. Authorized Official

Name: MR. JAMES BENEDICT BIRCHEM
Title or Position: PRESIDENT
Credential:
Phone: 320-631-0008