Healthcare Provider Details

I. General information

NPI: 1659942316
Provider Name (Legal Business Name): ARBOR VILLAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 HARPER AVE
PESHTIGO WI
54157-1134
US

IV. Provider business mailing address

620 HARPER AVE
PESHTIGO WI
54157-1134
US

V. Phone/Fax

Practice location:
  • Phone: 715-801-0388
  • Fax: 715-408-4481
Mailing address:
  • Phone: 715-801-0388
  • Fax: 715-408-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NANCY KAFURA
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-801-0388