Healthcare Provider Details

I. General information

NPI: 1952306748
Provider Name (Legal Business Name): COUNTY OF MONROE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 COUNTY HIGHWAY B
SPARTA WI
54656-4611
US

IV. Provider business mailing address

14400 COUNTY HIGHWAY B
SPARTA WI
54656-4611
US

V. Phone/Fax

Practice location:
  • Phone: 608-269-8800
  • Fax: 608-269-4386
Mailing address:
  • Phone: 608-269-8800
  • Fax: 608-269-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2379
License Number StateWI

VIII. Authorized Official

Name: GARLYNN M. BROOKSHAW
Title or Position: ACCOUNTANT
Credential:
Phone: 608-269-8818