Organization
THI OF WISCONSIN AT HARTFORD, LLC
Active
Other names
The Pavilion at Glacier Valley
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA OHMAN (PRESIDENT)
(262) 297-6300
Entity
Organization
Contact information
Practice address
1900 AMERICAN EAGLE DR, SLINGER, WI 53086-9043
(262) 297-6300
(262) 297-6301
Mailing address
1900 AMERICAN EAGLE DR, SLINGER, WI 53086-9043
(262) 297-6300
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20191500
—
WI
Enumeration date
10/07/2006
Last updated
03/25/2020
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