Healthcare Provider Details

I. General information

NPI: 1982015459
Provider Name (Legal Business Name): THOUSAND HILLS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2014
Last Update Date: 05/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N2359 SCHACHT RD
MARINETTE WI
54143-9735
US

IV. Provider business mailing address

N2359 SCHACHT RD
MARINETTE WI
54143-9735
US

V. Phone/Fax

Practice location:
  • Phone: 715-582-2940
  • Fax: 715-582-2940
Mailing address:
  • Phone:
  • Fax: 715-582-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number29899-020
License Number StateWI

VIII. Authorized Official

Name: KIMBERLEE THILL
Title or Position: MANAGER
Credential: RN
Phone: 715-923-2500