Healthcare Provider Details

I. General information

NPI: 1609876655
Provider Name (Legal Business Name): ARIZCONSIN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W PIONEER ST
CRANDON WI
54520-1554
US

IV. Provider business mailing address

PO BOX 400
CRANDON WI
54520-0400
US

V. Phone/Fax

Practice location:
  • Phone: 715-478-3324
  • Fax: 715-478-5085
Mailing address:
  • Phone: 715-478-3324
  • Fax: 715-478-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2945
License Number StateWI

VIII. Authorized Official

Name: MRS. PAMELA I RAU
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-478-3324