Healthcare Provider Details

I. General information

NPI: 1831859529
Provider Name (Legal Business Name): MENOMONIE AREA SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 6TH STREET EAST
MENOMONIE WI
54751
US

IV. Provider business mailing address

1412 6TH STREET EAST
MENOMONIE WI
54751
US

V. Phone/Fax

Practice location:
  • Phone: 715-235-0954
  • Fax: 715-235-1346
Mailing address:
  • Phone: 715-235-0954
  • Fax: 715-235-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARI LEE HOMSTAD
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 715-235-0954