NPIMap

Organization Active NPI

Pine Valley Integrated Services LLC

  • Community/Behavioral Health Agency
  • Mauston, WI
National Provider Identifier
1013375104
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PINE VALLEY INTEGRATED SERVICES LLC
Practice address
124 Grayside Ave
Mauston, WI 53948-1913
Phone
(608) 847-7575
Fax
(608) 847-3096
NPI assigned
Feb 3, 2016
Last updated
Aug 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Schulz
Title
Ceo / Owner Member LLC
Phone
(608) 847-7575

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

124 Grayside Ave
Mauston, WI 53948-1913

Mailing address

PO Box 359
Mauston, WI 53948-0359
Phone (608) 847-7575

Other practice location 1

W1889 Koval Rd
Lyndon Station, WI 53944-9398
Phone (608) 847-7575

Other names 1

  • Pine Valley Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160826000873 WI Part B Supplier - Clinic/Group Practice 2769777911 Receives reassigned benefits from 6 practitioners
Practice locations: Mauston, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1013375104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 359",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539480359",
            "telephone_number": "608-847-7575",
            "fax_number": "608-847-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 GRAYSIDE AVE",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481913",
            "telephone_number": "608-847-7575",
            "fax_number": "608-847-3096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W1889 Koval Rd",
            "address_purpose": "LOCATION",
            "city": "Lyndon Station",
            "state": "WI",
            "postal_code": "539449398",
            "country_code": "US",
            "telephone_number": "608-847-7575",
            "fax_number": "608-847-3096",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINE VALLEY INTEGRATED SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-03",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "SCHULZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CEO / OWNER MEMBER LLC",
        "authorized_official_telephone_number": "608-847-7575"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Valley Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mauston, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.