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General NPI Number Information
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NPI Number | 1346543246
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Entity Type | Organization
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Legal Business Name | DIVINE SAVIOR HEALTHCARE
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 2817 NEW PINERY RD SUITE 103
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City | PORTAGE
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State | WI
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Zip | 53901-9240
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Country | US
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Telephone | 608-745-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 2817 NEW PINERY RD SUITE 103
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City | PORTAGE
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State | WI
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Zip | 53901-9240
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Country | US
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Telephone | 608-745-6290
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Fax |
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Authorized Official
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Title or Position | ATHLETIC TRAINING SUPERVISOR
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Name | STEVE ALLISON
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Credential | LAT
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Telephone | 608-745-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 28-039
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License Number State | WI
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