Organization
STATE OF WISCONSIN
Active
Other names
Southern Wisconsin Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES E HUTCHISON (NURSING HOME ADMINISTRATOR)
(262) 878-2411
Entity
Organization
Contact information
Practice address
21425 SPRING ST, UNION GROVE, WI 53182-9707
(262) 878-2411
(262) 878-2922
Mailing address
21425 SPRING ST, UNION GROVE, WI 53182-9707
(262) 878-2411
(262) 878-2922
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2763
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21050000
—
WI
Enumeration date
08/22/2006
Last updated
02/14/2008
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