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General NPI Number Information
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NPI Number | 1982736831
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Entity Type | Organization
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Legal Business Name | COUNTY OF TREMPEALEAU
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 39906 COMMERCIAL AVE
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City | WHITEHALL
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State | WI
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Zip | 54773-2603
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Country | US
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Telephone | 715-983-5658
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Fax |
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Provider Business Mailing Address
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Address Line | W20410 STATE ROAD 121
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City | WHITEHALL
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State | WI
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Zip | 54773-9147
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Country | US
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Telephone | 715-538-4312
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Fax | 715-538-2426
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Authorized Official
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Title or Position | EXCECUTIVE DIRECTOR
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Name | MR. JERRY DEETZ
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Credential | N.H.A.
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Telephone | 715-538-4312
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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 | 11602
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License Number State | WI
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