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General NPI Number Information
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NPI Number | 1124028519
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Entity Type | Organization
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Legal Business Name | COUNTY OF SHAWANO
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | N4231 STATE HIGHWAY 22
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City | SHAWANO
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State | WI
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Zip | 54166-6130
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Country | US
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Telephone | 715-526-3158
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Fax | 715-526-6823
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Provider Business Mailing Address
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Address Line | N4231 STATE HIGHWAY 22
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City | SHAWANO
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State | WI
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Zip | 54166-6130
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Country | US
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Telephone | 715-526-3158
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Fax | 715-526-6823
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Authorized Official
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Title or Position | ACCOUNTANT/CONTROLLER
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Name | MRS. DEBBRA R KESSEN
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Credential |
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Telephone | 715-526-3158
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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 | 2579
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License Number State | WI
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