Healthcare Provider Details

I. General information

NPI: 1093701088
Provider Name (Legal Business Name): AUGUSTA AREA HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BRIDGE CREEK LN
AUGUSTA WI
54722-2603
US

IV. Provider business mailing address

901 BRIDGE CREEK LN
AUGUSTA WI
54722-2603
US

V. Phone/Fax

Practice location:
  • Phone: 715-286-2266
  • Fax: 715-286-2653
Mailing address:
  • Phone: 715-286-2266
  • Fax: 715-286-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2083
License Number StateWI

VIII. Authorized Official

Name: MR. JAHN B BRADLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-286-2266