Villa Vista, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

330912 Issued in MN

Legal business name

VILLA VISTA, INC.

Practice address

1197 Villa Vista Circle
Cromwell, MN 55726-0098

Phone

(218) 644-3331

Fax

(218) 644-3505

NPI assigned

Dec 29, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Julie R Peterson

Title

Administrator

Phone

(218) 644-3331

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760469878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1197 VILLA VISTA CIRCLE",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "557260098",
            "telephone_number": "218-644-3331",
            "fax_number": "218-644-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1197 VILLA VISTA CIRCLE",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "557260098",
            "telephone_number": "218-644-3331",
            "fax_number": "218-644-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLA VISTA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-644-3331",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MN",
            "license": "330912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly J. Goeb, M.D.
• Marcia Lillian Pocernich, PT
• Villa Court LLC
• Villa Court LLC
• Villa Home Care LLC

• All providers in Cromwell, MN
• Nursing Facility/Intermediate Care Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.