Healthcare Provider Details

I. General information

NPI: 1447258751
Provider Name (Legal Business Name): NU-ROC COMMUNITY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576A NU ROC LN
LAONA WI
54541-9291
US

IV. Provider business mailing address

3576A NU ROC LN
LAONA WI
54541-9291
US

V. Phone/Fax

Practice location:
  • Phone: 715-674-4477
  • Fax: 715-674-4016
Mailing address:
  • Phone: 715-674-4477
  • Fax: 715-674-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number913
License Number StateWI

VIII. Authorized Official

Name: MR. PAUL M NEWTON
Title or Position: ASST. ADMINISTRATOR
Credential:
Phone: 715-674-4477