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Organization
1311 TYLER STREET OPERATING COMPANY, LLC
Active
Organization
1311 TYLER STREET OPERATING COMPANY, LLC
Active
Other names
Atrium Post Acute Care of Black River Falls
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN P BRESLIN (MANAGER)
(973) 339-8892
Entity
Organization
Contact information
Practice address
1311 TYLER ST, BLACK RIVER FALLS, WI 54615-1564
(715) 284-4396
(715) 284-9580
Mailing address
1726 N BALLARD RD, APPLETON, WI 54911-2444
(920) 991-9072
(920) 749-4022
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3211
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336505791
—
WI
Enumeration date
01/14/2016
Last updated
04/05/2016
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