Provider Demographics
NPI:1205512399
Name:CECE'S STONE VILLA LLC
Entity type:Organization
Organization Name:CECE'S STONE VILLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VER VELDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-901-7186
Mailing Address - Street 1:7312 SHIRCEL RD
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-8842
Mailing Address - Country:US
Mailing Address - Phone:920-452-0556
Mailing Address - Fax:920-452-0558
Practice Address - Street 1:7312 SHIRCEL RD
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-8842
Practice Address - Country:US
Practice Address - Phone:920-452-0556
Practice Address - Fax:920-452-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child