Organization
CCG TOMAH INC.
Active
Other names
Tomah Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH YODER (CFO)
(614) 416-0600
Entity
Organization
Contact information
Practice address
1505 BUTTS AVE, TOMAH, WI 54660-2405
(608) 372-3241
(608) 372-3250
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
2825
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20192600
—
WI
01
—
621810991030
BCBS PROVIDER CODE
WI
Enumeration date
07/12/2005
Last updated
01/23/2008
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