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Organization
CCG PRESCOTT, INC
Active
Organization
CCG PRESCOTT, INC
Active
Other names
Prescott Nursing and Rehabilitation Community
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH YODER (CFO)
(614) 416-0600
Entity
Organization
Contact information
Practice address
1505 ORRIN RD, PRESCOTT, WI 54021-1074
(715) 262-5661
(715) 262-4899
Mailing address
5000 HAKES DR, SUITE 600, NORTON SHORES, MI 49441-5574
(231) 799-6870
(231) 799-0250
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3249
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20195300
—
WI
Enumeration date
08/19/2005
Last updated
01/23/2008
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