Healthcare Provider Details

I. General information

NPI: 1417214651
Provider Name (Legal Business Name): HEYDE HEALTH SYSTEM PEPIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SECOND ST.
PEPIN WI
54759-9658
US

IV. Provider business mailing address

345 FRENETTE DR
CHIPPEWA FALLS WI
54729-3372
US

V. Phone/Fax

Practice location:
  • Phone: 715-442-4811
  • Fax: 715-442-2904
Mailing address:
  • Phone: 715-726-9094
  • Fax: 715-723-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number13844
License Number StateWI

VIII. Authorized Official

Name: MARTIN C METTEN
Title or Position: EXECUTIVE VICE PRESIDENT/COO
Credential:
Phone: 715-726-9094