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General NPI Number Information
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NPI Number | 1518138593
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Entity Type | Organization
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Legal Business Name | GNP COUNTRY ESTATES LLC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 1610 25TH AVE S
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54495-4820
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Country | US
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Telephone | 715-423-1610
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Fax | 715-423-1611
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Provider Business Mailing Address
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Address Line | 1610 25TH AVE S
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54495-4820
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Country | US
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Telephone | 715-423-1610
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Fax | 715-423-1611
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Authorized Official
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Title or Position | MEMBER
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Name | ROBERTA GLEBKE
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Credential | NP
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Telephone | 715-213-6379
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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 |
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License Number State |
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