Provider Demographics
NPI:1518714203
Name:WELLNESS VILLAS HOLDING GROUP LLC
Entity type:Organization
Organization Name:WELLNESS VILLAS HOLDING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-825-0869
Mailing Address - Street 1:7353 W FOREST HOME AVE UNIT 20871
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-5815
Mailing Address - Country:US
Mailing Address - Phone:262-825-0869
Mailing Address - Fax:
Practice Address - Street 1:7353 W FOREST HOME AVE UNIT 20871
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-5815
Practice Address - Country:US
Practice Address - Phone:262-825-0869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251E00000XAgenciesHome Health