MEDICARE: TINA RIOS

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	311ZA0620X	Adult Care Home Facility	305581031	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	:	1528220472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINA RIOS

Provider Business Mailing Address
First Line	:	601 21ST ST
Second Line	:
City	:	PRAIRIE DU SAC
State	:	WI
Zip	:	53578-1068
Country	:	US
Telephone Number	:	608-643-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 21ST ST
Second Line	:
City	:	PRAIRIE DU SAC
State	:	WI
Zip	:	53578-1068
Country	:	US
Telephone Number	:	608-643-4643
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	TINA M RIOS
Credential	:
Telephone Number	:	608-643-4643

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/01/2008

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Directions to “TINA RIOS ” Practice Location

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