Provider Demographics
NPI:1386026029
Name:SOLOMON VALLEY VILLAGE
Entity Type:Organization
Organization Name:SOLOMON VALLEY VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:785-224-0509
Mailing Address - Street 1:120 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-2426
Mailing Address - Country:US
Mailing Address - Phone:785-534-1892
Mailing Address - Fax:
Practice Address - Street 1:120 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-2426
Practice Address - Country:US
Practice Address - Phone:785-534-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB062004311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)