Healthcare Provider Details

I. General information

NPI: 1013904085
Provider Name (Legal Business Name): COUNTY OF GRANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 HWY 61
LANCASTER WI
53813-9306
US

IV. Provider business mailing address

8800 HWY 61
LANCASTER WI
53813-9306
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-2113
  • Fax: 608-723-2210
Mailing address:
  • Phone: 608-723-2113
  • Fax: 608-723-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3108
License Number StateWI

VIII. Authorized Official

Name: MS. ALESHA ERDENBERGER
Title or Position: ADMINISTRATOR
Credential: N.H.A.
Phone: 608-723-2113