Healthcare Provider Details

I. General information

NPI: 1669683199
Provider Name (Legal Business Name): MARSH COUNTRY HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HOME RD
JUNEAU WI
53039-1401
US

IV. Provider business mailing address

199 HOME RD
JUNEAU WI
53039-1401
US

V. Phone/Fax

Practice location:
  • Phone: 920-386-3400
  • Fax: 920-386-3800
Mailing address:
  • Phone: 920-386-3400
  • Fax: 920-386-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2977
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JANE E HOOPER
Title or Position: ADMINISTRATOR
Credential: NHA RN
Phone: 920-386-3409