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General NPI Number Information
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NPI Number | 1003368200
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Entity Type | Organization
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Legal Business Name | DYCORA TRANSITIONAL HEALTH - ABBOTSFORD LLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 600 E ELM ST
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City | ABBOTSFORD
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State | WI
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Zip | 54405-9682
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Country | US
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Telephone | 715-223-2359
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E ELM ST
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City | ABBOTSFORD
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State | WI
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Zip | 54405-9682
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Country | US
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Telephone | 715-223-2359
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | MARY HAWKINS
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Credential |
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Telephone | 715-223-2359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2874
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License Number State | WI
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