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General NPI Number Information
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NPI Number | 1215981998
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Entity Type | Organization
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Legal Business Name | POLK COUNTY-DEPT OF ADMINISTRATION
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 220 SCHOLL CT
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City | AMERY
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State | WI
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Zip | 54001-1440
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Country | US
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Telephone | 715-268-7107
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Fax | 715-268-6167
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Provider Business Mailing Address
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Address Line | 220 SCHOLL CT
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City | AMERY
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State | WI
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Zip | 54001-1440
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Country | US
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Telephone | 715-268-7107
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Fax | 715-268-6167
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | DANA REESE
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Credential | LNHA
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Telephone | 715-268-7107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 2376
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License Number State | WI
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