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General NPI Number Information
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NPI Number | 1235627902
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE AT VILLA PINES LLC
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 201 S PARK AVE
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City | FRIENDSHIP
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State | WI
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Zip | 53934-9377
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Country | US
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Telephone | 608-339-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S PARK AVE
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City | FRIENDSHIP
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State | WI
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Zip | 53934-9377
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHALOM STEIN
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Credential |
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Telephone | 732-313-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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