Healthcare Provider Details

I. General information

NPI: 1518714203
Provider Name (Legal Business Name): WELLNESS VILLAS HOLDING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7353 W FOREST HOME AVE UNIT 20871
MILWAUKEE WI
53220-5815
US

IV. Provider business mailing address

7353 W FOREST HOME AVE UNIT 20871
MILWAUKEE WI
53220-5815
US

V. Phone/Fax

Practice location:
  • Phone: 262-825-0869
  • Fax:
Mailing address:
  • Phone: 262-825-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEJAN DRCA
Title or Position: PRESIDENT
Credential:
Phone: 262-825-0869