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General NPI Number Information
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NPI Number | 1215233127
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Entity Type | Organization
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Legal Business Name | AMERICANWAY OF SAUK COUNTY LLC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | S7559 US HIGHWAY 12
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City | NORTH FREEDOM
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State | WI
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Zip | 53951-9532
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Country | US
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Telephone | 608-643-2232
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Fax | 608-643-2841
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Provider Business Mailing Address
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Address Line | 602 E ALBERT ST SUITE 3
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City | PORTAGE
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State | WI
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Zip | 53901-1463
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Country | US
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Telephone | 608-566-1500
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Fax | 608-566-1501
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MRS. JANIS DEETS NOWAK
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Credential | CPA,NHA
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Telephone | 608-566-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | WI
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