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	251E00000X	Home Health Agency	349	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	349	OTHER	WI	HOME HEALTH AGENCY STATE LICENSURE

General Provider Information

NPI Number	:	1639326176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING VALLEY HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	W500 STATE ROAD 29
Second Line	:
City	:	SPRING VALLEY
State	:	WI
Zip	:	54767-9031
Country	:	US
Telephone Number	:	715-778-5045
Fax Number	:	715-778-4516

Provider Business Practice Location Address
First Line	:	W500 STATE ROAD 29
Second Line	:
City	:	SPRING VALLEY
State	:	WI
Zip	:	54767-9031
Country	:	US
Telephone Number	:	715-778-5045
Fax Number	:	715-778-4516

Authorized Official
Title or Position	:	ADMINISTRATOR/CEO
Name	:	MR. KEVIN H LARSON
Credential	:	CNHA
Telephone Number	:	715-778-5545

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	08/27/2008

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