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General NPI Number Information
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NPI Number | 1609876655
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Entity Type | Organization
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Legal Business Name | ARIZCONSIN GROUP INC
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 105 W PIONEER ST
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City | CRANDON
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State | WI
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Zip | 54520-1554
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Country | US
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Telephone | 715-478-3324
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Fax | 715-478-5085
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | CRANDON
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State | WI
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Zip | 54520-0400
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Country | US
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Telephone | 715-478-3324
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Fax | 715-478-5085
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PAMELA I RAU
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Credential |
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Telephone | 715-478-3324
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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 | 2945
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License Number State | WI
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