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Organization
COUNTY OF WOOD
Active
Organization
COUNTY OF WOOD
Active
Other names
Edgewater Haven Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE THEILER NHA (ADMINISTRATOR)
(715) 885-8324
Entity
Organization
Contact information
Practice address
1351 WISCONSIN RIVER DR, PORT EDWARDS, WI 54469-1041
(715) 885-8300
(715) 885-8351
Mailing address
1351 WISCONSIN RIVER DR, PORT EDWARDS, WI 54469-1099
(715) 885-8300
(715) 885-8351
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2369
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20131100
—
WI
Enumeration date
07/11/2005
Last updated
09/09/2022
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