Organization
CLARK COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE SCHMITZ (ADMINISTRATOR)
(715) 229-2172
Entity
Organization
Contact information
Practice address
W4266 STATE RD. 29, OWEN, WI 54460
(715) 229-2172
Mailing address
W4266 STATE RD. 29, OWEN, WI 54460
(715) 229-2172
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
314000000X
Skilled Nursing Facility
Primary
2387
WI
315P00000X
Intellectual Disabilities Intermediate Care Facility
3014
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20150100
—
WI
05
—
21052400
—
WI
05
—
40415200
—
WI
05
—
41011500
—
WI
Enumeration date
01/03/2007
Last updated
09/28/2011
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