Healthcare Provider Details

I. General information

NPI: 1982913240
Provider Name (Legal Business Name): VALLEY VILLAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S820 WESTLAND DR
SPRING VALLEY WI
54767-8241
US

IV. Provider business mailing address

S820 WESTLAND DR
SPRING VALLEY WI
54767-8241
US

V. Phone/Fax

Practice location:
  • Phone: 715-778-5535
  • Fax: 715-778-5540
Mailing address:
  • Phone: 715-778-5535
  • Fax: 715-778-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0013449
License Number StateWI

VIII. Authorized Official

Name: MR. KEVIN H. LARSON
Title or Position: ADMINISTRATOR/CEO
Credential: CNHA, BSHCA
Phone: 715-778-5545