Healthcare Provider Details

I. General information

NPI: 1932101136
Provider Name (Legal Business Name): VILLA MARIA HEALTH AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VILLA DR
HURLEY WI
54534-1523
US

IV. Provider business mailing address

300 VILLA DR
HURLEY WI
54534-1523
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-3200
  • Fax: 715-561-5556
Mailing address:
  • Phone: 715-561-3200
  • Fax: 715-561-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2660
License Number StateWI

VIII. Authorized Official

Name: MR. LAWRENCE J KUTZ
Title or Position: ADMINISTRATOR OWNER
Credential:
Phone: 715-561-3200