Pine Valley Community Village

LBN: County Of Richland
Pine Valley Community Village is an health care organization with primary practice located at 25951 Circle View Dr , Richland Center WI 53581-4013. The organization recently has 3 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Skilled Nursing Facility, Suppliers / Nursing Facility Supplies, Suppliers / Parenteral & Enteral Nutrition. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty. County Of Richland can be contacted via phone (608) 647-2138, or through Jimerson, Shaponda via phone (608) 647-2138.

Contact Information

Primary practice address
25951 Circle View Dr Richland Center WI 53581-4013
Phone: (608) 647-2138
Fax: (608) 647-8955
Website:
Map and Directions
Authorized official contact:
Name: Jimerson, Shaponda ADM
Phone: (608) 647-2138

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 2365 Wisconsin
Suppliers / Nursing Facility Supplies 332BN1400X 2365 Wisconsin
Suppliers / Parenteral & Enteral Nutrition 332BP3500X 2365 Wisconsin

Profile Details

NPI number 1144229055
LBN Legal business name County Of Richland
DBA Doing business as Pine Valley Community Village
Authorized official Jimerson, Shaponda ADM
Entity Organization
Organization subpart 1 No
Enumeration date Jul 21st, 2005
Last updated Feb 7th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144229055 NPPES
Wisconsin MEDICAID 20155800

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