Healthcare Provider Details

I. General information

NPI: 1194782318
Provider Name (Legal Business Name): MEMORIAL NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PARKER ST
BOSCOBEL WI
53805-1642
US

IV. Provider business mailing address

205 PARKER ST
BOSCOBEL WI
53805-1642
US

V. Phone/Fax

Practice location:
  • Phone: 608-375-6213
  • Fax:
Mailing address:
  • Phone: 608-375-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOIGENZAHN
Title or Position: FINANCE ADMINISTRATOR
Credential:
Phone: 608-375-6228