Healthcare Provider Details

I. General information

NPI: 1699983221
Provider Name (Legal Business Name): LA CROSSE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 GARLAND ST E
WEST SALEM WI
54669-1308
US

IV. Provider business mailing address

962 GARLAND ST E
WEST SALEM WI
54669-1308
US

V. Phone/Fax

Practice location:
  • Phone: 608-612-0651
  • Fax:
Mailing address:
  • Phone: 608-612-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5025
License Number StateWI

VIII. Authorized Official

Name: MS. WANDA PLACHECKI
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 608-612-0640