Healthcare Provider Details

I. General information

NPI: 1447559364
Provider Name (Legal Business Name): HYLAND PARK COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 CADDIS BND
FITCHBURG WI
53711-7105
US

IV. Provider business mailing address

5440 CADDIS BND
FITCHBURG WI
53711-7105
US

V. Phone/Fax

Practice location:
  • Phone: 608-270-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number0013255
License Number StateWI

VIII. Authorized Official

Name: ANN SIMONSON
Title or Position: PROPERTY MANAGER
Credential:
Phone: 608-318-1180