1134123573 NPI number — VILLA MARINA HEALTH AND REHABILITATION CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134123573 NPI number — VILLA MARINA HEALTH AND REHABILITATION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLA MARINA HEALTH AND REHABILITATION CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134123573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 VILLA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURLEY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54534-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-561-3200
Provider Business Mailing Address Fax Number:
715-561-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 NORTH 28TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54880-5557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-392-3300
Provider Business Practice Location Address Fax Number:
715-392-9660
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KUTZ
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-561-3200

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  3215 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20102400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com