Healthcare Provider Details

I. General information

NPI: 1366437006
Provider Name (Legal Business Name): PEPIN OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 2ND ST
PEPIN WI
54759-9658
US

IV. Provider business mailing address

1110 SECOND STREET
PEPIN WI
54759-9658
US

V. Phone/Fax

Practice location:
  • Phone: 715-442-4811
  • Fax: 715-442-2904
Mailing address:
  • Phone: 715-442-4811
  • Fax: 715-442-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3165
License Number StateWI

VIII. Authorized Official

Name: STUART LINDEMEN
Title or Position: CEO & PRESIDENT
Credential:
Phone: 813-280-1333