Healthcare Provider Details

I. General information

NPI: 1336198191
Provider Name (Legal Business Name): NORTHERN LIGHTS SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 BRATLEY DR
WASHBURN WI
54891-1143
US

IV. Provider business mailing address

706 BRATLEY DR
WASHBURN WI
54891-1143
US

V. Phone/Fax

Practice location:
  • Phone: 715-373-5621
  • Fax: 715-373-5244
Mailing address:
  • Phone: 715-373-5621
  • Fax: 715-373-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2624
License Number StateWI

VIII. Authorized Official

Name: PAULINE DARLING
Title or Position: CEO/NHA
Credential:
Phone: 715-373-6424