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General NPI Number Information
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NPI Number | 1629217062
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Entity Type | Organization
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Legal Business Name | RELIV OF SOUTHERN WISCONSIN
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 201 PRAIRIE VIEW DR
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City | BEAVER DAM
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State | WI
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Zip | 53916-3406
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Country | US
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Telephone | 920-356-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 305 S CLARK ST
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City | MAYVILLE
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State | WI
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Zip | 53050-1488
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Country | US
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Telephone | 920-356-0681
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN VP NUTRITION
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Name | MR. VITTORIO GIUSEPPE SPADARO SR.
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Credential |
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Telephone | 920-356-0681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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