MEDICARE: ADRC OF WASHINGTON COUNTY

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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1316397441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADRC OF WASHINGTON COUNTY

Provider Business Mailing Address
First Line	:	333 E WASHINGTON ST STE 1000
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-2501
Country	:	US
Telephone Number	:	262-335-4497
Fax Number	:	262-335-4717

Provider Business Practice Location Address
First Line	:	333 E WASHINGTON ST STE 1000
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-2501
Country	:	US
Telephone Number	:	262-335-4497
Fax Number	:	262-335-4717

Authorized Official
Title or Position	:	SUPERVISOR, ELDER NUTRITION/WELLNES
Name	:	KRISTEN HOSKING
Credential	:	R.D., C.D.
Telephone Number	:	262-335-4497

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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Directions to “ADRC OF WASHINGTON COUNTY ” Practice Location

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