Healthcare Provider Details

I. General information

NPI: 1306831052
Provider Name (Legal Business Name): HEYDE HEALTH SYSTEM OCONTO FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E HIGHLAND DR
OCONTO FALLS WI
54154-1001
US

IV. Provider business mailing address

345 FRENETTE DR
CHIPPEWA FALLS WI
54729-3372
US

V. Phone/Fax

Practice location:
  • Phone: 920-848-3272
  • Fax: 920-848-2516
Mailing address:
  • Phone: 715-726-9094
  • Fax: 715-723-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2727
License Number StateWI

VIII. Authorized Official

Name: MR. DENNIS L HEYDE
Title or Position: PRESIDENT
Credential:
Phone: 715-726-9094