Healthcare Provider Details

I. General information

NPI: 1447176920
Provider Name (Legal Business Name): COUNTRY GET AWAY ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 COUNTY HIGHWAY A
BLOOMER WI
54724-3954
US

IV. Provider business mailing address

2170 COUNTY HIGHWAY A
BLOOMER WI
54724-3954
US

V. Phone/Fax

Practice location:
  • Phone: 715-568-1962
  • Fax: 715-568-1962
Mailing address:
  • Phone: 715-568-1962
  • Fax: 715-568-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATOYIA WOODARD
Title or Position: OWNER
Credential: ADULT DAY CARE
Phone: 715-568-1962