Healthcare Provider Details

I. General information

NPI: 1134208218
Provider Name (Legal Business Name): SANNES SKOGDALEN NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SUNSHINE BLVD
SOLDIERS GROVE WI
54655-0177
US

IV. Provider business mailing address

PO BOX 177 101 SUNSHINE BLVD
SOLDIERS GROVE WI
54655-0177
US

V. Phone/Fax

Practice location:
  • Phone: 608-624-5244
  • Fax: 608-624-3478
Mailing address:
  • Phone: 608-624-5244
  • Fax: 608-624-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2607
License Number StateWI

VIII. Authorized Official

Name: MRS. JACQUELINE H CARLEY
Title or Position: CFO/NHA
Credential: CFO/NHA
Phone: 608-624-5244