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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