MEDICARE: COUNTY OF RICHLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BN1400X	Nursing Facility Supplies (DME)	2365	WI
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	2365	WI
3	314000000X	Skilled Nursing Facility	2365	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144229055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RICHLAND

Provider Business Mailing Address
First Line	:	25951 CIRCLE VIEW DR
Second Line	:
City	:	RICHLAND CENTER
State	:	WI
Zip	:	53581-4013
Country	:	US
Telephone Number	:	608-647-2138
Fax Number	:	608-647-8955

Provider Business Practice Location Address
First Line	:	25951 CIRCLE VIEW DR
Second Line	:
City	:	RICHLAND CENTER
State	:	WI
Zip	:	53581-4013
Country	:	US
Telephone Number	:	608-647-2138
Fax Number	:	608-647-8955

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHAPONDA JIMERSON
Credential	:	ADM
Telephone Number	:	608-647-2138

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/07/2024

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Directions to “COUNTY OF RICHLAND ” Practice Location

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