MEDICARE: SPRING VALLEY HEALTH CARE SERVICES, INC.

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	995	WI
2	314000000X	Skilled Nursing Facility	995	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	995	OTHER	WI	WI NRSNG FCLTY LICENSE NO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548246929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING VALLEY HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	S830 WESTLAND DRIVE
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 DRIVE
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	:	ADMINISTRATOR/CEO
Name	:	MR. KEVIN H. LARSON
Credential	:	CNHA
Telephone Number	:	715-778-5545

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	02/23/2016

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