Healthcare Provider Details

I. General information

NPI: 1801892435
Provider Name (Legal Business Name): FIRST AMERICAN ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WEST NEWTON ST
RICE LAKE WI
54868-1744
US

IV. Provider business mailing address

19 WEST NEWTON ST
RICE LAKE WI
54868-1744
US

V. Phone/Fax

Practice location:
  • Phone: 715-234-2161
  • Fax: 715-234-1705
Mailing address:
  • Phone: 715-234-2161
  • Fax: 715-234-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2463
License Number StateWI

VIII. Authorized Official

Name: DARLENE A DENUCCI
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-234-2161