NPIMap

Organization Active NPI

Pine Valley Residential Services

  • Mental Illness Community Based Residential Treatment Facility
  • Mauston, WI
National Provider Identifier
1891126751
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
AFH Issued in WI
Legal business name
PINE VALLEY RESIDENTIAL SERVICES
Practice address
124 Grayside Ave
Mauston, WI 53948-1913
Phone
(608) 847-7575
Fax
(608) 847-3096
NPI assigned
Dec 3, 2013
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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 7163-123 WI
Community/Behavioral Health Agency 251S00000X 7163-123 WI
Mental Illness Community Based Residential Treatment Facility 320800000X AFH WI Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X AFH WI

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1386028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1891126751",
    "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 RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-03",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WI",
            "license": "7163-123",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "7163-123",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "WI",
            "license": "AFH",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": "AFH",
            "primary": false
        }
    ],
    "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.