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General NPI Number Information
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NPI Number | 1417214651
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Entity Type | Organization
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Legal Business Name | HEYDE HEALTH SYSTEM PEPIN LLC
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 1112 SECOND 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 | 345 FRENETTE DR
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3372
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Country | US
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Telephone | 715-726-9094
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Fax | 715-723-1205
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT/COO
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Name | MARTIN C METTEN
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Credential |
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Telephone | 715-726-9094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 13844
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License Number State | WI
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