| NPI | 1144229055 |
|---|---|
| Doing Business As | PINE VALLEY COMMUNITY VILLAGE |
| Entity Type | Organization |
| Authorized Contact | SHAPONDA JIMERSON Administrator 608-647-2138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WI 2365) |
| Additional Taxonomies | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: WI 2365) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: WI 2365) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2024-02-07 |