Healthcare Provider Details

I. General information

NPI: 1043563968
Provider Name (Legal Business Name): ACADIA FINISHERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 PARADISE DR
WEST BEND WI
53095-7870
US

IV. Provider business mailing address

1911 PARADISE DR
WEST BEND WI
53095-7870
US

V. Phone/Fax

Practice location:
  • Phone: 262-338-1000
  • Fax:
Mailing address:
  • Phone: 262-338-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number1128658
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number1128658
License Number StateWI

VIII. Authorized Official

Name: MR. JOHN P MCHUGH
Title or Position: PRESIDENT
Credential:
Phone: 262-338-1000