Provider Demographics
NPI:1003056706
Name:VILLA COURT LLC
Entity Type:Organization
Organization Name:VILLA COURT LLC
Other - Org Name:CARDINAL COURT AND VILLA VISTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-644-3331
Mailing Address - Street 1:1220 VILLA COURT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:MN
Mailing Address - Zip Code:55726-0000
Mailing Address - Country:US
Mailing Address - Phone:218-644-3331
Mailing Address - Fax:218-644-3505
Practice Address - Street 1:1220 VILLA COURT DRIVE
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:MN
Practice Address - Zip Code:55726-0000
Practice Address - Country:US
Practice Address - Phone:218-644-3331
Practice Address - Fax:218-644-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343408310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility