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General NPI Number Information
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NPI Number | 1104814664
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Entity Type | Organization
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Legal Business Name | LEDGE VIEW NURSING CENTER
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3737 DICKINSON RD
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City | DE PERE
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State | WI
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Zip | 54115-8797
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Country | US
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Telephone | 920-336-7733
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Fax | 920-339-7885
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Provider Business Mailing Address
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Address Line | 3737 DICKINSON RD
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City | DE PERE
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State | WI
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Zip | 54115-8797
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Country | US
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Telephone | 920-336-7733
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Fax | 920-339-7885
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RONALD J DESOTELL
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Credential |
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Telephone | 920-336-7733
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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 | 3105
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License Number State | WI
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