=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184798761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF IOWA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 10/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3151 COUNTY ROAD CH
-----------------------------------------------------
City | DODGEVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53533-9108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-935-3321
-----------------------------------------------------
Fax | 608-935-3962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 N IOWA ST
-----------------------------------------------------
City | DODGEVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53533-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-935-0397
-----------------------------------------------------
Fax | 608-935-6024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSING HOME ADMINISTRATOR
-----------------------------------------------------
Name | MS. BARBARA B LINSCHEID
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 608-935-3321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 2364
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------