Healthcare Provider Details

I. General information

NPI: 1528056819
Provider Name (Legal Business Name): SAUK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CLARK ST
REEDSBURG WI
53959-2321
US

IV. Provider business mailing address

1051 CLARK ST
REEDSBURG WI
53959-2321
US

V. Phone/Fax

Practice location:
  • Phone: 608-524-7500
  • Fax: 608-524-7579
Mailing address:
  • Phone: 608-524-7500
  • Fax: 608-524-7579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2397
License Number StateWI

VIII. Authorized Official

Name: MRS. THERESA KATHLEEN DIETZ
Title or Position: BUSINESS MANAGER
Credential:
Phone: 608-524-7500