MEDICARE: VILLAGE OF SPRING VALLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1336981026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF SPRING VALLEY

Provider Business Mailing Address
First Line	:	S830 WESTLAND DR
Second Line	:
City	:	SPRING VALLEY
State	:	WI
Zip	:	54767-8238
Country	:	US
Telephone Number	:	715-778-5545
Fax Number	:	715-778-5575

Provider Business Practice Location Address
First Line	:	S830 WESTLAND DR
Second Line	:
City	:	SPRING VALLEY
State	:	WI
Zip	:	54767-8238
Country	:	US
Telephone Number	:	715-778-5545
Fax Number	:	715-778-5575

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THERESA KOCH
Credential	:
Telephone Number	:	715-307-7417

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/28/2024

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Directions to “VILLAGE OF SPRING VALLEY ” Practice Location

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