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General NPI Number Information
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NPI Number | 1053549980
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Entity Type | Organization
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Legal Business Name | ST PAUL ELDER SERVICES INC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 316 E 14TH ST
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City | KAUKAUNA
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State | WI
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Zip | 54130-3304
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Country | US
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Telephone | 920-766-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 316 E 14TH ST
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City | KAUKAUNA
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State | WI
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Zip | 54130-3304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGEMENT
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Name | MARY MILLER
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Credential |
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Telephone | 920-766-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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