Country Grove Home LLC

NPI #1306162706 in Necedah, Wisconsin

Provider Information

NPI Number: 1306162706
Entity Type: Organization
Organization Name: Country Grove Home LLC
Primary Specialty: Assisted Living Facility - Assisted Living, Mental Illness
Enumeration Date: Apr 12, 2010
Last Updated: Apr 12, 2010

Practice Location

Address: N11151 17TH AVE
City: Necedah
State: Wisconsin
ZIP Code: 54646-7619
Phone: (608) 565-2735

Authorized Official

Name: MR. SCOTT A PEAK
Title: OWNER
Phone: (608) 547-2755

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility - Assisted Living, Mental Illness — Assisted Living, Mental Illness	3104A0625X	Primary

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