Provider Demographics
NPI:1982913240
Name:VALLEY VILLAS, LLC
Entity Type:Organization
Organization Name:VALLEY VILLAS, LLC
Other - Org Name:VALLEY VILLAS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA, BSHCA
Authorized Official - Phone:715-778-5545
Mailing Address - Street 1:S820 WESTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-8241
Mailing Address - Country:US
Mailing Address - Phone:715-778-5535
Mailing Address - Fax:715-778-5540
Practice Address - Street 1:S820 WESTLAND DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:WI
Practice Address - Zip Code:54767-8241
Practice Address - Country:US
Practice Address - Phone:715-778-5535
Practice Address - Fax:715-778-5540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING VALLEY HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013449310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0013449OtherSTATE LICENSURE CERTIFICATION