Healthcare Provider Details

I. General information

NPI: 1831101864
Provider Name (Legal Business Name): COUNTY OF COLUMBIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W. MONROE ST.
WYOCENA WI
53969
US

IV. Provider business mailing address

323 W. MONROE ST. P.O. BOX 895
WYOCENA WI
53969
US

V. Phone/Fax

Practice location:
  • Phone: 608-429-2181
  • Fax: 608-429-2607
Mailing address:
  • Phone:
  • Fax: 608-429-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2418
License Number StateWI

VIII. Authorized Official

Name: MRS. AMY E YAMRISKA
Title or Position: NURSING HOME ADMINISTRATOR
Credential: NHA
Phone: 608-429-2181