Organization
VILLA PINES FACILITIES LLC
Active
Other names
Villa Pines Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
SERGEI SHVETZOFF (DIRECTOR)
(763) 537-5700
Entity
Organization
Contact information
Practice address
201 S PARK AVE, FRIENDSHIP, WI 53934-9377
(608) 339-3361
(608) 339-9468
Mailing address
12900 WHITEWATER DR STE 201, HOPKINS, MN 55343-9407
(637) 527-5700
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3089
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20196000
—
WI
Enumeration date
02/28/2006
Last updated
11/06/2019
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