MEDICARE: PHM NEW RICHMOND SENIOR HOUSINIG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1326285826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHM NEW RICHMOND SENIOR HOUSINIG INC

Provider Business Mailing Address
First Line	:	1127 W 8TH ST
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-1467
Country	:	US
Telephone Number	:	715-243-3900
Fax Number	:	715-243-3901

Provider Business Practice Location Address
First Line	:	2845 HAMLINE AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55113-7127
Country	:	US
Telephone Number	:	651-631-6000
Fax Number	:	651-631-6122

Authorized Official
Title or Position	:	CAMPUS ADMIN
Name	:	JOANN WRICH
Credential	:
Telephone Number	:	715-243-3903

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/21/2009

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