MEDICARE: ARIZCONSIN GROUP 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	314000000X	Skilled Nursing Facility	2945	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2945	OTHER	WI	FACIOLITY LICENSE NUMBER

General Provider Information

NPI Number	:	1609876655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZCONSIN GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	CRANDON
State	:	WI
Zip	:	54520-0400
Country	:	US
Telephone Number	:	715-478-3324
Fax Number	:	715-478-5085

Provider Business Practice Location Address
First Line	:	105 W PIONEER ST
Second Line	:
City	:	CRANDON
State	:	WI
Zip	:	54520-1554
Country	:	US
Telephone Number	:	715-478-3324
Fax Number	:	715-478-5085

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PAMELA I RAU
Credential	:
Telephone Number	:	715-478-3324

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/08/2007

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Directions to “ARIZCONSIN GROUP INC ” Practice Location

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