Healthcare Provider Details

I. General information

NPI: 1164408266
Provider Name (Legal Business Name): LAFAYETTE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 E CATHERINE ST
DARLINGTON WI
53530-1330
US

IV. Provider business mailing address

719 E CATHERINE ST
DARLINGTON WI
53530-1330
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-4472
  • Fax: 608-776-4473
Mailing address:
  • Phone: 608-776-4472
  • Fax: 608-776-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2448
License Number StateWI

VIII. Authorized Official

Name: JULIE M. CHIKOWSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 608-776-4472