Provider Demographics
NPI:1972140333
Name:NORTHWOODS VILLA INC.
Entity Type:Organization
Organization Name:NORTHWOODS VILLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-244-8731
Mailing Address - Street 1:1905 W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4738
Mailing Address - Country:US
Mailing Address - Phone:218-999-4644
Mailing Address - Fax:218-999-0100
Practice Address - Street 1:1905 W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4738
Practice Address - Country:US
Practice Address - Phone:218-999-4644
Practice Address - Fax:218-999-0100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWOODS VILLA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health