Provider Demographics
NPI:1841033313
Name:NORTHWOODS VILLA INC.
Entity type:Organization
Organization Name:NORTHWOODS VILLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTENHOFEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN/LALD
Authorized Official - Phone:218-244-8731
Mailing Address - Street 1:1801 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-3126
Mailing Address - Country:US
Mailing Address - Phone:218-324-6170
Mailing Address - Fax:
Practice Address - Street 1:1801 4TH AVE E
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-3126
Practice Address - Country:US
Practice Address - Phone:218-324-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWOODS VILLA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness