Organization
PINE VALLEY RESIDENTIAL SERVICES
Active
Other names
Pine Valley Services
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA SCHULZ (CEO / OWNER MEMBER LLC)
(608) 847-7575
Entity
Organization
Contact information
Practice address
124 GRAYSIDE AVE, MAUSTON, WI 53948-1913
(608) 847-7575
(608) 847-3096
Mailing address
PO BOX 359, MAUSTON, WI 53948-0359
(608) 847-7575
(608) 847-3096
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
7163-123
WI
251S00000X
Community/Behavioral Health Agency
7163-123
WI
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
AFH
WI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AFH
WI
Other
Enumeration date
12/03/2013
Last updated
08/28/2023
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