Healthcare Provider Details

I. General information

NPI: 1144229055
Provider Name (Legal Business Name): COUNTY OF RICHLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25951 CIRCLE VIEW DR
RICHLAND CENTER WI
53581-4013
US

IV. Provider business mailing address

25951 CIRCLE VIEW DR
RICHLAND CENTER WI
53581-4013
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-2138
  • Fax: 608-647-8955
Mailing address:
  • Phone: 608-647-2138
  • Fax: 608-647-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number2365
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number2365
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2365
License Number StateWI

VIII. Authorized Official

Name: SHAPONDA JIMERSON
Title or Position: ADMINISTRATOR
Credential: ADM
Phone: 608-647-2138