Provider Demographics
NPI:1851842611
Name:PEACE VILLA INC.
Entity Type:Organization
Organization Name:PEACE VILLA INC.
Other - Org Name:THE HAVEN AT PEACE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOUSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-467-9683
Mailing Address - Street 1:600 RAILROAD DR
Mailing Address - Street 2:
Mailing Address - City:NORWOOD YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55368-2601
Mailing Address - Country:US
Mailing Address - Phone:952-467-3692
Mailing Address - Fax:952-467-3156
Practice Address - Street 1:600 RAILROAD DR
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368-2601
Practice Address - Country:US
Practice Address - Phone:952-467-3692
Practice Address - Fax:952-467-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN378221310400000X
MN378632311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA080412300OtherMHCP - MINNESOTA DEPT. OF HUMAN SERVICES