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General NPI Number Information
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NPI Number | 1063370120
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Entity Type | Organization
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Legal Business Name | MYSTIC ACRES, LLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 12878 COUNTY HIGHWAY I
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City | VIOLA
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State | WI
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Zip | 54664-8709
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Country | US
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Telephone | 608-553-1753
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Fax |
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Provider Business Mailing Address
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Address Line | 17969 WILSON SPRINGS RD
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-8588
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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 | OWNER
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Name | DIANE COOK
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Credential |
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Telephone | 608-553-1753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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