Organization
COUNTY OF TREMPEALEAU
Active
Parent organization
COUNTY OF TREMPEALEAU
Other names
Hickory Ridge Adult Family Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF TREMPEALEAU
Authorized official
JERRU DEETZ N.H.A (EXECUTIVE DIRECTOR)
(715) 538-4312
Entity
Organization
Contact information
Practice address
W17306 ARNESON RIDGE RD., BLAIR, WI 54616
(608) 989-2018
Mailing address
W20410 STATE ROAD 121, WHITEHALL, WI 54773-9147
(715) 538-4312
(715) 538-2426
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
11796
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11796
ADULT FAMILY HOME
WI
Enumeration date
03/09/2007
Last updated
04/15/2021
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