Healthcare Provider Details

I. General information

NPI: 1841359536
Provider Name (Legal Business Name): COUNTY OF GRANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S JEFFERSON ST FL 2
LANCASTER WI
53813-1672
US

IV. Provider business mailing address

111 S JEFFERSON ST FL 2
LANCASTER WI
53813-1672
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-6416
  • Fax: 608-723-6501
Mailing address:
  • Phone: 608-723-6416
  • Fax: 608-723-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number516
License Number StateWI

VIII. Authorized Official

Name: JEFFERY A KINDRAI
Title or Position: DIRECTOR, HEALTH OFFICER
Credential: MSPH, RS
Phone: 608-723-6416