Organization
PROVINCE TERRACE VILLAS LONG CT. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANNE MARIA REEVES (ADMINISTRATOR)
(920) 257-2573
Entity
Organization
Contact information
Practice address
5216 LONG COURT, APPLETON, WI 54914
(920) 257-2573
(920) 882-0295
Mailing address
5216 LONG CT, APPLETON, WI 54914-9111
(920) 257-2573
(920) 882-0295
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
0012777
WI
Other
Enumeration date
12/17/2009
Last updated
12/17/2009
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