State of Wisconsin
NPI #1043326747 in Union Grove, Wisconsin
Provider Information
- NPI Number
- 1043326747
- Entity Type
- Organization
- Organization Name
- State of Wisconsin
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Aug 22, 2006
- Last Updated
- Feb 14, 2008
Practice Location
- Address
- 21425 SPRING ST
- City
- Union Grove
- State
- Wisconsin
- ZIP Code
- 53182-9707
- Phone
- (262) 878-2411
Authorized Official
- Name
- MR. JAMES E HUTCHISON
- Title
- NURSING HOME ADMINISTRATOR
- Phone
- (262) 878-2411
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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