Healthcare Provider Details

I. General information

NPI: 1215233127
Provider Name (Legal Business Name): AMERICANWAY OF SAUK COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S7559 US HIGHWAY 12
NORTH FREEDOM WI
53951-9532
US

IV. Provider business mailing address

602 E ALBERT ST SUITE 3
PORTAGE WI
53901-1463
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-2232
  • Fax: 608-643-2841
Mailing address:
  • Phone: 608-566-1500
  • Fax: 608-566-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateWI

VIII. Authorized Official

Name: MRS. JANIS DEETS NOWAK
Title or Position: SOLE MEMBER
Credential: CPA,NHA
Phone: 608-566-1500