Healthcare Provider Details

I. General information

NPI: 1396741252
Provider Name (Legal Business Name): WOODLANDS OF OCONTO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 1ST ST
OCONTO WI
54153-1117
US

IV. Provider business mailing address

430 MANOR DR
SURING WI
54174-9182
US

V. Phone/Fax

Practice location:
  • Phone: 920-834-4575
  • Fax: 920-834-2537
Mailing address:
  • Phone: 920-842-1111
  • Fax: 920-842-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5009
License Number StateWI

VIII. Authorized Official

Name: MS. MARY DUFEK
Title or Position: ADMINISTRATOR
Credential:
Phone: 920-834-4575