Organization
SANNES SKOGDALEN NURSING FACILITY LLC
Active
Other names
Sannes Skogdalen Heim
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE H CARLEY CFO/NHA (CFO/NHA)
(608) 624-5244
Entity
Organization
Contact information
Practice address
101 SUNSHINE BLVD, SOLDIERS GROVE, WI 54655-0177
(608) 624-5244
(608) 624-3478
Mailing address
PO BOX 177, 101 SUNSHINE BLVD, SOLDIERS GROVE, WI 54655-0177
(608) 624-5244
(608) 624-3478
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2607
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20193600
MEDICAID PROVIDER NUMBER
WI
01
—
525622
MEDICARE PROVIDER NUMBER
WI
Enumeration date
11/02/2006
Last updated
12/26/2012
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