Healthcare Provider Details

I. General information

NPI: 1750915575
Provider Name (Legal Business Name): COUNTY OF LA CROSSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 GARLAND ST E
WEST SALEM WI
54669
US

IV. Provider business mailing address

962 GARLAND ST E
WEST SALEM WI
54669
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-0168
  • Fax: 608-793-6604
Mailing address:
  • Phone: 608-786-1400
  • Fax: 608-793-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: WANDA GIBNEY
Title or Position: EXECUTIVE DIRECTOR LONG TERM CARE &
Credential:
Phone: 608-612-0643