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General NPI Number Information
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NPI Number | 1912944810
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Entity Type | Organization
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Legal Business Name | OMRO HEALTHCARE LLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 500 GRANT AVE
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City | OMRO
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State | WI
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Zip | 54963-1342
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Country | US
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Telephone | 920-685-2755
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Fax | 920-685-0599
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Provider Business Mailing Address
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Address Line | 500 GRANT AVE
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City | OMRO
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State | WI
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Zip | 54963-1342
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Country | US
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Telephone | 920-685-2755
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Fax | 920-685-0599
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Authorized Official
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Title or Position | MANAGER
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Name | WILLIAM R. WATSON II
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Credential |
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Telephone | 920-685-2755
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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 | 3241
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License Number State | WI
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