Organization
ST JOSEPH RESIDENCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL W ORR (ADMINISTRATOR)
(920) 982-5354
Entity
Organization
Contact information
Practice address
107 E BECKERT ROAD, NEW LONDON, WI 54961-2598
(920) 982-5354
(920) 982-5420
Mailing address
107 E BECKERT ROAD, NEW LONDON, WI 54961-2598
(920) 982-5354
(920) 982-5420
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2040
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20132400
—
WI
Enumeration date
06/28/2005
Last updated
08/22/2020
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