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General NPI Number Information
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NPI Number | 1447244108
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Entity Type | Organization
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Legal Business Name | MULDER HEALTH CARE FACILITY, INC
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 713 N LEONARD ST
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City | WEST SALEM
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State | WI
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Zip | 54669-0850
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Country | US
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Telephone | 608-786-1600
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Fax | 608-786-0740
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Provider Business Mailing Address
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Address Line | 713 N LEONARD ST PO BOX 850
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City | WEST SALEM
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State | WI
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Zip | 54669-0850
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Country | US
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Telephone | 608-786-1600
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Fax | 608-786-0740
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | MR. RONALD GENE GILBERTSON
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Credential | NURSING HOME ADMINIS
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Telephone | 608-786-1600
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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 | 1031
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License Number State | WI
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