Healthcare Provider Details

I. General information

NPI: 1750324687
Provider Name (Legal Business Name): COUNTY OF VERNON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 FAIRLANE DR
VIROQUA WI
54665-6137
US

IV. Provider business mailing address

310 FAIRLANE DR
VIROQUA WI
54665-6137
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-5400
  • Fax: 608-637-5441
Mailing address:
  • Phone: 608-637-5400
  • Fax: 608-637-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2678
License Number StateWI

VIII. Authorized Official

Name: KIMBERLY GOCHANOUR
Title or Position: CEO
Credential:
Phone: 608-788-5700