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General NPI Number Information
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NPI Number | 1013792597
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Entity Type | Organization
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Legal Business Name | RASCALS RESORT LLC
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 29429 COUNTY HIGHWAY V
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City | KENDALL
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State | WI
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Zip | 54638-8518
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Country | US
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Telephone | 608-463-7377
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Fax |
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Provider Business Mailing Address
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Address Line | W10000 STATE ROAD 82
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City | ELROY
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State | WI
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Zip | 53929-9454
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Country | US
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Telephone | 608-548-5006
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Fax |
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Authorized Official
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Title or Position | SOLE BOARD MEMBER
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Name | MISSY ANDREWS
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Credential |
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Telephone | 608-548-5006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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