Healthcare Provider Details

I. General information

NPI: 1841535341
Provider Name (Legal Business Name): SNF CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7137 236TH AVE STE 103
SALEM WI
53168-8975
US

IV. Provider business mailing address

7137 236TH AVE STE 103
SALEM WI
53168-8975
US

V. Phone/Fax

Practice location:
  • Phone: 262-843-4422
  • Fax: 262-843-1166
Mailing address:
  • Phone: 262-843-4422
  • Fax: 262-843-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN J HETTRICK
Title or Position: PHYSICIAN
Credential: MD
Phone: 262-843-2394