Province Terrace Villas Long CT. LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

0012777 Issued in WI

Legal business name

PROVINCE TERRACE VILLAS LONG CT. LLC

Practice address

5216 Long Court
Appleton, WI 54914

Phone

(920) 257-2573

Fax

(920) 882-0295

NPI assigned

Dec 17, 2009

Organization subpart

No

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

Authorized official

Name

Roxanne Maria Reeves

Title

Administrator

Phone

(920) 257-2573

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261008000000",
    "number": "1427387661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5216 LONG CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549149111",
            "telephone_number": "920-257-2573",
            "fax_number": "920-882-0295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5216 LONG COURT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54914",
            "telephone_number": "920-257-2573",
            "fax_number": "920-882-0295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVINCE TERRACE VILLAS LONG CT. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2009-12-17",
        "status": "A",
        "authorized_official_last_name": "REEVES",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-257-2573"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": "0012777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Appleton, WI
• Providers in Appleton, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.