MEDICARE: HEYDE HEALTH SYSTEM, 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	0008936	WI

General Provider Information

NPI Number	:	1518953199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEYDE HEALTH SYSTEM, INC

Provider Business Mailing Address
First Line	:	345 FRENETTE DR
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-3372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 N 14TH ST
Second Line	:
City	:	BLACK RIVER FALLS
State	:	WI
Zip	:	54615-1931
Country	:	US
Telephone Number	:	715-284-4397
Fax Number	:	715-284-7786

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DENNIS L HEYDE
Credential	:
Telephone Number	:	715-726-9094

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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