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General NPI Number Information
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NPI Number | 1366437006
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Entity Type | Organization
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Legal Business Name | PEPIN OPERATOR, LLC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 1110 2ND ST
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City | PEPIN
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State | WI
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Zip | 54759-9658
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Country | US
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Telephone | 715-442-4811
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Fax | 715-442-2904
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Provider Business Mailing Address
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Address Line | 1110 SECOND STREET
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City | PEPIN
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State | WI
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Zip | 54759-9658
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Country | US
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Telephone | 715-442-4811
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Fax | 715-442-2904
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | STUART LINDEMEN
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Credential |
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Telephone | 813-280-1333
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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 | 3165
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License Number State | WI
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