Healthcare Provider Details

I. General information

NPI: 1659856599
Provider Name (Legal Business Name): LADYSMITH ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 LAKE AVE W
LADYSMITH WI
54848-1210
US

IV. Provider business mailing address

518 LAKE AVE W
LADYSMITH WI
54848-1210
US

V. Phone/Fax

Practice location:
  • Phone: 715-532-4000
  • Fax: 715-609-1444
Mailing address:
  • Phone: 715-532-4000
  • Fax: 715-609-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETH CHERISMA PETERSON
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 715-532-4000