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General NPI Number Information
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NPI Number | 1528220472
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Entity Type | Organization
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Legal Business Name | TINA RIOS
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 601 21ST ST
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-1068
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Country | US
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Telephone | 608-643-4643
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Fax |
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Provider Business Mailing Address
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Address Line | 601 21ST ST
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-1068
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Country | US
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Telephone | 608-643-4643
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | TINA M RIOS
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Credential |
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Telephone | 608-643-4643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 305581031
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License Number State | WI
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