Organization
NEW GLARUS HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID WICKLINE (AUTHORIZED OFFICIAL)
(608) 527-2126
Entity
Organization
Contact information
Practice address
600 2ND AVE, NEW GLARUS, WI 53574-9776
(608) 527-2126
(608) 527-5365
Mailing address
600 2ND AVE, NEW GLARUS, WI 53574-9776
(608) 527-2126
(608) 527-5365
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2605
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20104200
—
WI
Enumeration date
10/03/2005
Last updated
10/21/2024
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